Effectiveness of a community-based nutrition education intervention on metabolic control and diet and lifestyle behaviors among adults with type 2 diabetes in a low-resource primary care setting in Honduras

Evidence on scalable, culturally adapted nutrition education for type 2 diabetes (T2D) in low-resource settings remains limited. We conducted a 12-week quasi-experimental study among 50 adults with T2D attending a primary care clinic (intervention n = 25; control n = 25). The intervention included weekly group sessions on healthy eating, portion control, food label reading, and age-appropriate physical activity, plus individualized diet plans. Sociodemographic, anthropometric, biochemical, diet, and behavioral measures were assessed at baseline and after 12 weeks. Comparisons between the intervention and control groups were performed using the Mann-Whitney U test (α = 0.05). The intervention group showed significant improvements in glycated hemoglobin (from 8.4 ± 1.6% to 7.9 ± 1.5%; p < 0.01) and both systolic and diastolic blood pressure (p < 0.001). Diet and lifestyle behaviors differed significantly between groups, including lower reported consumption of whole milk, refined cereals, industrial pastries, and added sugars (all p < 0.001), as well as higher time spent in moderate physical activity (Δ = +0.42 h/day; p = 0.04) and walking (Δ = +0.22 h/day; p = 0.02), and lower sedentary time (Δ = −0.5 h/day; p = 0.04). No significant changes were observed in lipid parameters (all p > 0.05). A low-cost, community-based nutrition education program embedded in primary care was associated with improved metabolic and behavioral outcomes among adults with T2D in a low-resource context. Findings support the scalability and relevance of culturally adapted diabetes education for similar settings across low- and middle-income countries.