Lifestyle intervention outcomes in T2DM and the added value of CGM: 6-month results from the Polish cohort of the C4D study

Lifestyle intervention outcomes in T2DM and the added value of CGM: 6-month results from the Polish cohort of the C4D study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Lifestyle intervention outcomes in T2DM and the added value of CGM: 6-month results from the Polish cohort of the C4D study Joanna Ostrowska, Ewa Kobos, Mariola Pietrzak, Agata Szymczak, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9169658/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Type 2 diabetes remains a major public health challenge, requiring lifelong management. Structured lifestyle-based interventions are increasingly recognised for their role in supporting self-management. The CARE4DIABETES (C4D) programme, part of a Joint Action funded by the EU4Health initiative, aims to implement and evaluate a behavioural lifestyle model (Reverse Diabetes2 Now) across 12 European countries. Methods C4D is a 12-month, quasi-experimental, structured, digitally supported lifestyle programme comprising multiple group-based educational sessions delivered by a multidisciplinary team (MDT) and addressing nutrition, physical activity, sleep, and stress management. This interim analysis includes the Polish cohort (n = 38; type 2 diabetes duration ≤ 10 years), presented overall and stratified by continuous glucose monitoring (CGM) users (n = 21) versus self-monitoring of blood glucose (SMBG, n = 17). Results At 6 months, participants showed significant improvements. Mean HbA1c decreased by 0.78 percentage points (–10.9%; p < 0.001) to 6.35%. Body weight decreased by 6.04 kg (–6.5%; p < 0.001), waist circumference by 6.77 cm (–6.4%; p < 0.001), fat mass by 2.47 kg (–7.2%; p < 0.001), and triglycerides by 20.3% (p = 0.023), while total cholesterol, LDL-C, and HDL-C did not change significantly. Improvements were numerically larger in the CGM group. Between-group comparisons of change scores showed greater reductions in body weight and BMI in the CGM group compared with the SMBG group (p < 0.05; Cohen’s d ≈ 0.9–1.0). Conclusion The 6-month intensive phase of this structured, group-based lifestyle education programme was associated with clinically meaningful improvements in glycaemic control and anthropometric outcomes. Improvements were greater among CGM users than in the SMBG group, suggesting that integrating CGM into structured education may further enhance programme outcomes. Health sciences/Diseases Health sciences/Endocrinology Health sciences/Health care Health sciences/Medical research type 2 diabetes lifestyle self-monitoring of blood glucose (SMBG) continuous glucose monitoring (CGM) HbA1c weight loss 1. Introduction Type 2 diabetes (T2DM) is the most common form of diabetes, accounting for over 90% of cases worldwide, and its prevalence continues to rise [ 1 ]. Evidence consistently shows that weight reduction and long-term weight maintenance, achieved through appropriate dietary changes and increased physical activity, are central to the management of T2DM. Such lifestyle changes improve glycaemic control and other major cardiometabolic risk factors, including blood pressure, lipid profile, and inflammatory status [ 2 , 3 ]. As a chronic condition, T2DM requires daily self-management, regular monitoring of metabolic parameters, and numerous decisions made in everyday life. For this reason, patient education is a cornerstone of effective care and has long been recognised as a standard component of diabetes management. Recent recommendations from the European Association for the Study of Diabetes (EASD) and the Diabetes Nutrition Study Group (DNSG) underline the value of long-term, structured education programmes delivered by multidisciplinary teams (MDT) and grounded in behavioural therapy, as these approaches help patients understand and implement sustainable health behaviours and thereby support durable weight loss [ 4 ]. Importantly, clinically meaningful and sustained weight loss may allow dose reduction of glucose-lowering medication and, in some individuals, contribute to T2DM remission [ 5 ]. The Polish Diabetes Association (PTD) also recommends that structured education and ongoing re-education should be available to all people with T2DM and their carers and emphasises delivery by a qualified MDT [ 6 ]. Education can be delivered individually or in groups, in-person, remotely, or in hybrid formats, with possible involvement of family members or carers. Group-based programmes led by MDTs have been linked to better metabolic outcomes, higher treatment satisfaction, and stronger motivation for lifestyle change [ 7 , 8 ]. Some studies suggest they may be at least as effective as individual education and, in certain settings, more effective in sustaining long term benefits [ 9 ]. Tele-education is also gaining importance through educational platforms and mobile applications, telephone and video consultations, webinars, e-learning, and SMS reminders [ 10 ]. Available evidence further suggests that tele-education may be comparable to traditional approaches and, in some analyses, was associated with a greater reduction in HbA1c (mean difference − 0.3%; 95% CI: −0.42 to − 0.19) [ 11 , 12 ]. Within this context, continuous glucose monitoring (CGM) may further strengthen lifestyle education by providing detailed glucose profiles that help patients and clinicians link everyday behaviours (such as meals, physical activity, sleep, and stress) to glucose patterns. The most effective approaches are therefore likely to combine digital tools (including CGM) with structured education and behavioural support tailored to individual needs and capacities [ 10 ]. An example of such an integrated model is CARE4DIABETES (C4D), a year-long structured lifestyle programme delivered within a Joint Action involving 30 partners from 12 European Union countries (Belgium, Bulgaria, Slovakia, Slovenia, Finland, Greece, Hungary, Italy, Malta, Poland, Portugal, and Spain as the consortium lead). C4D implemented an intensive, outpatient lifestyle education programme for people with T2DM to support active self-management. The intervention is based on the Dutch programme ReverseDiabetes2Now (developed by Voeding Leeft) [ 13 – 16 ], which has been implemented in the Netherlands for a decade and was recognised by the European Union as a “best practice” before being piloted in participating countries, including Poland. According to data reported by Voeding Leeft, 92% of people with T2DM achieved metabolic control after 12 months of participation, allowing partial or complete discontinuation of pharmacotherapy [ 13 ]. The programme targets four core lifestyle domains: diet, physical activity, stress management, and sleep duration and quality, and differs from usual care through its group-based structure (approximately 20 participants per group), the intensity of delivery (six full-day sessions), and its strong emphasis on therapeutic lifestyle change, with diet as a central component. In this study, we addressed two questions. First, we assessed whether participation in a structured lifestyle intervention was associated with improvements in glycaemic control and body composition over 6 months in individuals with T2DM. Second, we evaluated whether adding CGM to the same programme was associated with greater improvements in metabolic outcomes compared with participation without CGM. 2. Methods 2.1. Study design and setting CARE4DIABETES (C4D) is a 12-month, quasi-experimental study implemented across 12 European countries, adapted from the Dutch “Reverse Diabetes 2Now” best practice [ 13 – 16 ]. The study methodology has been described in detail in the published protocol [ 17 ]. In brief, C4D is a 12-month, structured lifestyle programme for adults with type 2 diabetes (up to 10 years since diagnosis), delivered by a MDT through multiple group-based educational sessions covering four domains: nutrition, physical activity, sleep, and relaxation/stress management [ 17 ]. 2.2. Participants and eligibility Participants were adults with physician diagnosed T2DM recruited from a Polish primary care clinic. Eligible patients were invited by their general practitioners (GP), who also provided clinical follow-up during the programme. Inclusion criteria were in line with the C4D protocol [ 17 ]: adults aged 20–80 years with type 2 diabetes of 1–10 years’ duration, a BMI of 25–40 kg/m², and pharmacological treatment (oral and/or injectable agents, including insulin). Use of GLP-1 receptor agonists or SGLT-2 inhibitors required a minimum of 6 months on a stable dose/regimen prior to programme start. Further eligibility requirements included the absence of major contraindications to participation (e.g., COPD, heart failure, severe renal impairment defined as eGFR < 30 mL/min/1.73 m², prior bariatric surgery, eating disorders, or pregnancy), willingness to engage in lifestyle change, adequate language proficiency, access to and ability to use an internet-enabled device, and willingness to perform home blood glucose monitoring. In Poland, 38 participants were enrolled. All participants took part in the same structured lifestyle intervention, delivered through educational sessions in two cohorts of similar size. The cohorts differed only in the glucose monitoring method used: one cohort used CGM (n = 21), whereas the other used standard SMBG with a glucometer (n = 17), in line with instructions provided by the physician and nurse within the MDT. 2.3. Intervention C4D is a structured education programme grounded in behavioural change principles (I-Change model) [ 18 ] and designed to help participants practise and integrate new habits rather than only receive information. The programme lasts 12 months and includes two consecutive stages: (I) a 6-month intensive training phase and (II) a 6-month aftercare phase. The 6-month intensive phase consisted of six full-day, structured group sessions delivered by the MDT (GP/diabetologist, dietitian, psychologist, and nurse) and focused on key behavioural therapy components: diet, physical activity, stress coping, and healthy sleep. In Poland, sessions were delivered in a hybrid format: four face-to-face workshops and two remote (telematic) workshops. Workshops took place at programme start (kick-off meeting with an overnight stay), and then at months 1 (remote), 3 (face-to-face), 4.5 (remote), and 6 (face-to-face). A distinctive feature of the in-person component was an overnight kick-off meeting. The aim was to build group cohesion and encourage early engagement by removing participants from their usual routines, reducing exposure to triggers (e.g., habitual snacking), and providing an added layer of support (particularly for those using medications associated with hypoglycaemia). Key components of the intervention are described in the published protocol [ 17 ]. In brief, the programme combines education with practical activities. Sessions covered healthy eating principles, meal planning and preparation, cooking classes, food label reading, practical recipe modification, supervised physical exercises, relaxation techniques, and basic coaching practices. Behavioural support was embedded throughout, using group work and peer support to maintain motivation and facilitate adherence. Participants also received introductory education on T2DM pathophysiology, interpretation of daily glucose patterns, biometric feedback, and practical self-management strategies. The entire intervention was supported by a digital platform enabling peer interaction and contact with the MDT, facilitating ongoing coaching and medical monitoring. Throughout the programme, participants were supervised by the MDT, and medication adjustments were made when clinically indicated. As described above, one group used CGM, and the second group followed SMBG. In the CGM group, FreeStyle Libre 2 sensors (Abbott Diabetes Care) were applied according to a predefined schedule: two 14-day sensors at baseline, one 14-day sensor at 3 months, and one 14-day sensor at 6 months of the lifestyle intervention. Outside these CGM periods, participants measured capillary blood glucose using glucometers, following physician and nurse instructions provided by the physician and nurse within the MDT. 2.4. Data Collection Clinical, anthropometric, and body composition measures were collected by the MDT using standardised procedures at baseline and at 6 months, in line with the protocol measurement schedule [ 17 ]. Although the protocol also includes an assessment at 12 months, the present paper reports interim outcomes for the Polish cohort based on baseline and 6-month data only. Body weight and height were measured using a Seca 799 measuring station (column scale) with a precision of ± 0.1 kg and ± 0.1 cm, respectively. Waist circumference was measured using a steel tape positioned midway between the lower rib margin and the iliac crest, in the horizontal plane. Body composition was assessed using bioelectrical impedance analysis (BIA) with a multi-frequency segmental analyzer (Tanita MC-780MA, Tanita Corporation, Tokyo, Japan) following the manufacturer’s instructions. Participants were asked to follow the European Society for Clinical Nutrition and Metabolism (ESPEN) recommendations [ 19 ]. Specifically, they were instructed to fast for at least 2–3 h before testing, avoid physical activity for 12 h, abstain from alcohol and caffeinated or carbonated beverages for 24 h, and empty their bladder 30 min prior to the assessment. Biochemical measurements included HbA1c (%), total cholesterol (mg/dL), HDL cholesterol (mg/dL), LDL cholesterol (mg/dL), and triglycerides (mg/dL). 2.5. Statistical analysis Analyses were performed in participants with paired measurements at baseline and 6 months. Continuous variables are presented as mean ± SD. Within-participant changes were evaluated using paired t-tests; normality of the change scores was assessed (Shapiro–Wilk test), and when the normality assumption was not met, the Wilcoxon signed-rank test was used as a sensitivity analysis. Two-sided p-values < 0.05 were considered statistically significant. Effect sizes were quantified using Cohen’s d for paired data, and 95% confidence intervals for mean changes were calculated using the t distribution. Participants were additionally stratified by glucose monitoring method (CGM vs SMBG). Between group differences in baseline to 6-month change scores (ΔCGM vs ΔSMBG) were evaluated using an independent-samples t-test; when distributional assumptions were not met, the Mann–Whitney U test was used as a sensitivity analysis. Between-group effect sizes were expressed as Cohen’s d for independent groups (based on change scores) and interpreted as small (|d| < 0.2), medium (0.2 ≤ |d| < 0.5), large (0.5 ≤ |d| < 0.8), and very large (|d| ≥ 0.8). Because multiple outcomes were analysed, p-values were interpreted descriptively without adjustment for multiple comparisons. 2.6. Ethics The Polish implementation received approval from the Bioethics Committee at the Medical University of Warsaw (No. KB/270/2023, 13 November 2023). All methods were performed in accordance with relevant guidelines and regulations, and the study was conducted in accordance with the Declaration of Helsinki. All participants received a participant information sheet and provided written informed consent prior to participation. 3. Results A total of 38 participants were included in the baseline analysis (CGM, n = 21; SMBG, n = 17). The cohort was predominantly female (63.2%), with a mean age of 56.13 ± 11.17 years. At baseline, mean body weight was 95.45 ± 16.61 kg and mean BMI was 32.06 ± 4.73 kg/m², corresponding to obesity on average, while mean waist circumference was 106.71 ± 10.97 cm, indicating substantial central adiposity. Mean HbA1c was 7.20 ± 1.67% - above commonly used glycaemic targets for adults with type 2 diabetes. Lipid parameters were as follows: total cholesterol 179.45 ± 39.76 mg/dl, HDL cholesterol 47.17 ± 11.36 mg/dl, LDL cholesterol 104.38 ± 37.55 mg/dl, and triglycerides 163.68 ± 78.95 mg/dl. Baseline anthropometric, body composition and metabolic characteristics for the total sample and by subgroup are summarised in Table 1. Descriptively, the CGM group tended to have higher adiposity and higher HbA1c than the SMBG group, while lipid values were broadly similar between groups. Table 1 Baseline characteristics of the study group (n=38) Parameter All (Baseline) (M ± SD / n (%)) CGM (Baseline) (M ± SD / n (%)) SMBG (Baseline) (M ± SD / n (%)) N 38 21 17 Sex: female, n (%) 24 (63.2%) 14 (66.7%) 10 (58.8%) Sex: male, n (%) 14 (36.8%) 7 (33.3%) 7 (41.2%) Age (years) 56.13 ± 11.17 57.0 ± 12.1 55.06 ± 10.15 Body weight (kg) 95.45 ± 16.61 101.39 ± 17.78 88.12 ± 11.8 Height (m) 1.7 ± 0.09 1.71 ± 0.09 1.69 ± 0.09 BMI (kg/m²) 32.06 ± 4.73 33.55 ± 5.26 30.93 ± 3.1 Waist circumference (cm) 106.71 ± 10.97 108.95 ± 11.73 103.94 ± 9.58 Fat mass (kg) 36.21 ± 11.14 39.63 ± 11.19 31.98 ± 9.81 Visceral fat 13.39 ± 4.3 14.71 ± 4.42 11.76 ± 3.63 FFM (kg) 60.1 ± 11.01 61.66 ± 11.95 58.17 ± 9.73 Muscle mass (kg) 57.09 ± 10.5 58.57 ± 11.39 55.26 ± 9.28 Total body water 44.59 ± 6.16 44.49 ± 5.71 44.72 ± 6.83 HbA1c (%) 7.2 ± 1.67 7.67 ± 1.94 6.62 ± 1.06 Total cholesterol (mg/dl) 179.45 ± 39.76 176.33 ± 40.63 183.29 ± 39.55 HDL cholesterol (mg/dl) 47.17 ± 11.36 46.59 ± 9.69 47.88 ± 13.41 LDL cholesterol (mg/dl) 104.38 ± 37.55 100.88 ± 40.03 108.71 ± 34.95 Triglycerides (mg/dl) 163.68 ± 78.95 149.19 ± 56.74 181.59 ± 98.85 Abbreviations: M – mean; SD – standard deviation; HbA1c – glycated hemoglobin; BMI – body mass index; FFM – fat-free mass; LDL – low-density lipoprotein cholesterol; HDL – high-density lipoprotein cholesterol; SMBG - self-monitoring of blood glucose; CGM - continuous glucose monitoring Out of the 38 participants enrolled in Poland, 31 completed the 6-month intensive phase and had paired baseline and 6-month data available for analysis. After 6 months, glycaemic control improved significantly: mean HbA1c decreased from 7.13% to 6.35% (mean change −0.78 percentage points; p < 0.001; large effect). In parallel, participants achieved clinically meaningful reductions in anthropometric outcomes, with an average weight loss of 6.0 kg and a waist circumference reduction of 6.8 cm (both p < 0.001), alongside a significant decrease in BMI (−2.11 kg/m²; p < 0.001; very large effects for weight-related outcomes). Body composition analyses indicated a significant decrease in fat mass (−2.47 kg; p < 0.001) and a reduction in visceral fat (−0.93; p = 0.001). However, reductions were also observed in fat-free mass (−1.89 kg) and estimated muscle mass (−2.19 kg) (both p < 0.001), suggesting that weight loss was accompanied by losses in lean tissue. Total body water percentage did not change significantly (p = 0.153). In the lipid profile, triglycerides decreased significantly (−34.9 mg/dL; p = 0.023), whereas changes in total cholesterol and LDL cholesterol were modest and did not reach statistical significance; HDL cholesterol remained stable. Detailed results are presented in Table 2. Table 2 Changes in metabolic and anthropometric parameters after 6-month lifestyle intervention (n=31) Parameter Baseline (M ± SD) 6-month (M ± SD) Change (M ± SD) 95% CI for Change Change (%) p-value Sig. Cohen's d Effect size HbA1c (%) 7.13 ± 1.68 6.35 ± 1.13 -0.78 ± 1.06 (-1.17, -0.39) -10.9% < 0.001 *** -0.73 large Body weight (kg) 92.89 ± 15.81 86.85 ± 14.6 -6.04 ± 4.69 (-7.76, -4.32) -6.5% < 0.001 *** -1.29 very large BMI (kg/m²) 32.06 ± 4.34 29.94 ± 3.75 -2.11 ± 1.65 (-2.72, -1.51) -6.6% < 0.001 *** -1.28 very large Waist circumference (cm) 105.74 ± 10.75 98.97 ± 9.45 -6.77 ± 4.51 (-8.43, -5.12) -6.4% < 0.001 *** -1.5 very large Fat mass (kg) 34.44 ± 10.48 31.97 ± 9.51 –2.47 ± 3.02 (-3.62, -1.32) –7.2% < 0.001 *** –0.82 very large Visceral fat 13.45 ± 4.13 12.52 ± 4.01 -0.93 ± 1.41 (-1.47, -0.39) -6.9% 0.001 ** -0.66 large FFM (kg) 59.50 ± 11.31 57.61 ± 11.48 –1.89 ± 2.06 (-2.67, -1.1) –3.2% < 0.001 *** –0.92 very large Muscle mass (kg) 56.52 ± 10.79 54.33 ± 11.31 –2.19 ± 2.69 (-3.21, -1.17) –3.9% < 0.001 *** –0.81 very large Total body water (%) 44.65 ± 5.95 45.49 ± 5.93 0.84 ± 3.10 (-0.33, 2.02) +1.9% 0.153 ns 0.27 medium Triglycerides (mg/dl) 171.48 ± 82.09 136.61 ± 56.81 -34.87 ± 80.96 (-64.57, -5.18) -20.3% 0.023 * -0.43 medium Total cholesterol (mg/dl) 176.1 ± 39.46 167.03 ± 46.35 -9.06 ± 26.63 (-18.83, 0.7) -5.1% 0.068 ns -0.34 medium LDL cholesterol (mg/dl) 100.75 ± 40.03 94.69 ± 39.06 -6.06 ± 24.7 (-15.12, 3.0) -6.0% 0.182 ns -0.25 medium HDL cholesterol (mg/dl) 46.59 ± 11.59 46.16 ± 10.59 -0.43 ± 7.07 (-3.03, 2.16) -0.9% 0.736 ns -0.06 small Abbreviations: M – mean; SD – standard deviation; 95% CI – 95% confidence interval; HbA1c – glycated hemoglobin; BMI – body mass index; FFM – fat-free mass; LDL – low-density lipoprotein cholesterol; HDL – high-density lipoprotein cholesterol; ns – not significant. * p < 0.05; ** p < 0.01; *** p < 0.001. Table 3 summarizes changes in metabolic and anthropometric parameters after 6 months in 31 participants who completed a 6‑month group-based structured educational programme, stratified into two groups: participants using CGM (n=17) and participants using SMBG (n=14). Overall, both groups showed improvements in metabolic control and reductions in weight-related measures. The largest between-group differences were observed for body weight and BMI, with greater reductions in the CGM group compared with the SMBG group (between-group comparison of change significant for both outcomes). For most other outcomes (including HbA1c, waist circumference, lipid profile, and body composition measures), changes were generally favourable in both groups; however, between-group differences were smaller and mostly did not reach statistical significance, and effect sizes ranged from small to very large depending on the outcome. Notably, changes were generally more pronounced in the CGM group than in the SMBG group, although this pattern was not consistent for all lipid outcomes. Table 3 Changes in metabolic and anthropometric parameters after 6 months (CGM n= 17 vs SMBG n=14) Parameter CGM Baseline (M ± SD) CGM 6 mo (M ± SD) Δ CGM (p-value) SMBG Baseline (M ± SD) SMBG 6 mo (M ± SD) Δ SMBG (p-value) p-value (between groups) Cohen's d Effect Size HbA1c (%) 7.6 ± 2.0 6.6 ± 1.4 -1.0 ± 1.1 ** 6.6 ± 1.0 6.0 ± 0.6 -0.6 ± 1.0 ns 0.296 -0.38 Medium Body weight (kg) 98.6 ± 16.7 90.6 ± 14.8 -7.9 ± 4.1 *** 86.0 ± 11.8 82.2 ± 13.5 -3.8 ± 4.5 ** 0.012 * -0.97 Very large BMI (kg/m²) 33.6 ± 4.8 30.8 ± 3.8 -2.7 ± 1.5 *** 30.2 ± 2.9 28.8 ± 3.5 -1.4 ± 1.6 ** 0.019 * -0.90 Very large Waist circumference (cm) 108.4 ± 10.9 101.0 ± 8.9 -7.4 ± 4.1 *** 102.5 ± 10.0 96.5 ± 9.9 -6.0 ± 5.0 *** 0.395 -0.31 Medium Fat mass (kg) 38.4 ± 10.1 35.8 ± 9.1 -2.6 ± 3.2 ** 30.2 ± 9.4 27.8 ± 8.4 -2.4 ± 3.0 * 0.884 -0.05 Small Visceral fat 15.1 ± 3.8 13.9 ± 3.9 -1.3 ± 1.6 *** 11.6 ± 3.8 11.1 ± 3.8 -0.6 ± 1.1 ns 0.190 -0.50 Large FFM (kg) 61.6 ± 12.2 59.2 ± 12.1 -2.4 ± 1.9 *** 57.2 ± 10.2 55.9 ± 11.0 -1.3 ± 2.1 * 0.145 -0.56 Large Muscle mass (kg) 58.5 ± 11.6 56.2 ± 11.5 -2.3 ± 1.9 *** 54.4 ± 9.8 52.3 ± 11.1 -2.0 ± 3.4 * 0.782 -0.10 Small Triglycerides (mg/dl) 152.6 ± 56.8 139.1 ± 54.5 -13.6 ± 60.5 ns 194.4 ± 102.7 133.6 ± 61.4 -60.7 ± 96.5 * 0.108 0.60 Large Total cholesterol (mg/dl) 168.8 ± 38.1 156.4 ± 43.3 -12.4 ± 17.4 ** 184.9 ± 40.6 179.9 ± 48.2 -5.0 ± 35.1 ns 0.450 -0.28 Medium LDL cholesterol (mg/dl) 93.5 ± 42.6 85.1 ± 36.8 -8.4 ± 17.0 ns 109.6 ± 36.3 106.4 ± 39.8 -3.2 ± 32.2 ns 0.565 -0.21 Medium HDL cholesterol (mg/dl) 45.3 ± 10.2 45.8 ± 10.2 0.5 ± 7.2 ns 48.1 ± 13.3 46.6 ± 11.4 -1.6 ± 7.0 ns 0.428 0.29 Medium Abbreviations: M – mean; SD – standard deviation; HbA1c – glycated hemoglobin; BMI – body mass index; FFM – fat-free mass; LDL – low-density lipoprotein cholesterol; HDL – high-density lipoprotein cholesterol; ns – not significant; SMBG - self-monitoring of blood glucose; CGM - continuous glucose monitoring p < 0.05; ** p < 0.01; *** p < 0.001. 4. Discussion This study evaluated a 6-month lifestyle intervention in individuals with T2DM, with analyses stratified by glucose monitoring method (CGM vs. glucometer-based SMBG). At baseline, the study population had a mean BMI in the obese range and a mean HbA1c level above the general therapeutic target for T2DM recommended by the Polish Diabetes Association (PTD) [6]. After 6 months of participation in the C4D programme, glycaemic control improved in a statistically significant and clinically meaningful manner, as reflected by a reduction in mean HbA1c. HbA1c remains the key marker for assessing glycaemic control in type 2 diabetes and has a well-established predictive value for diabetes related complications [20–22]. In the overall study group, HbA1c decreased by 0.78 percentage points to 6.35%, which is consistent with the general PTD treatment target of ≤7% [6]. These results are consistent with evidence from other structured lifestyle programmes. The ReverseDiabetes2Now programme implemented in the Netherlands, which informed the design of C4D, also reported improvements in glycaemic outcomes [13]. Other lifestyle programmes have likewise reported marked metabolic benefits, including substantial weight loss, improved glycaemic control, and, in some cases, diabetes remission. In the DiRECT trial, 24% of participants lost at least 15 kg and 46% achieved remission at 12 months [23]. In the Virta Health programme, HbA1c decreased from 7.6% to 6.3% after 1 year, alongside a mean weight loss of 13.8 kg [24]. Further support comes from a lifestyle programme delivered in California (USA), where HbA1c decreased progressively over 24 weeks and remission was reported in 8% of participants [25]. Consistent reductions in HbA1c after 6 months of intervention have also been reported in studies conducted in Spain [26], Taiwan [27], and Lebanon [28]. Over 6 months, the reduction in HbA1c was larger in the CGM group than in the SMBG group, however, the between-group difference did not reach statistical significance, which may partly reflect the limited sample size. These findings align with available evidence suggesting that CGM can be a useful tool to support education and lifestyle decision making in T2DM, both in dietary interventions and in multicomponent lifestyle programmes, with potential benefits for glycaemic outcomes and body weight [29]. In the randomised Steno2Tech study, CGM use among insulin-treated individuals with type 2 diabetes was associated with greater improvements in time in range (TIR), HbA1c, and BMI compared with standard glucometer-based SMBG [30]. Improved glycaemic control has also been reported with CGM use in people with type 2 diabetes who are not treated with insulin [31,32] The study demonstrated significant reductions in body weight (approximately 6 kg on average), waist circumference (about 6.8 cm), and BMI (−2.11 kg/m²) over the 6-month intervention period. These findings are consistent with results from other programmes combining dietary modification and physical activity, including the SLIMMER programme, where favourable changes in body weight, diet quality, and physical activity were shown to persist during follow-up after the intervention ended [33]. A weight loss of 5–7% is generally considered clinically meaningful and is typically associated with improved glycaemic control [10,34]. Evidence from observational and interventional studies further suggests that greater reductions in adiposity, including body fat percentage, waist circumference, and BMI, may translate into larger improvements in HbA1c [35,36]. An association between higher BMI and poorer glycaemic control has also been reported in population-based analyses [37]. In the subgroup analyses, greater reductions in body weight and BMI were observed among participants using CGM. It may be hypothesised that immediate feedback on glucose levels facilitated dietary adjustments and increased engagement in lifestyle change [10,38]. Diet and physical activity are central to maintaining glycaemic homeostasis, and CGM may strengthen patients’ capacity for self-management by providing real-time feedback and helping to reduce glucose variability [39]. In line with this, a systematic review reported that, compared with control conditions, CGM use was associated with behavioural changes, including longer daily physical activity time and lower daily energy and carbohydrate intake [40]. Available evidence also suggests that, in people with type 2 diabetes, CGM can support tighter glycaemic control compared with SMBG [31], and CGM-based feedback has shown a moderate beneficial effect on glycaemic outcomes when used to support behaviour change in adults with and without diabetes [41]. By visualising glucose values as continuous curves, CGM can help patients understand the relationships between diet, physical activity, other lifestyle factors, and glycaemic outcomes, which may contribute to greater perceived self-efficacy in behaviour change [42]. In this study, we observed significant reductions from baseline in both FFM and estimated muscle mass in participants using CGM as well as those using SMBG. Such changes may accompany weight loss, particularly when dietary protein intake is insufficient and resistance training is not performed regularly [43]. Epidemiological data indicate that the prevalence of sarcopenia is approximately threefold higher in people with diabetes than in those without diabetes, and in type 2 diabetes it has been estimated at around 18% [44]. Therefore, teams delivering lifestyle interventions should include an assessment of sarcopenia risk, particularly in older adults (in this study, the mean age was 65 years), in those with lower BMI (which in this context may reflect lower muscle mass reserves), higher HbA1c, and longer diabetes duration. In practice, this highlights the importance of adequate protein intake and incorporating resistance exercises as key components to reduce the risk of muscle mass loss during weight reduction [45,46]. In addition, the reduction in FFM was consistent with the overall decrease in body weight and abdominal circumference observed during the intervention. Nevertheless, because BIA-derived estimates of FFM depend largely on total body water, some influence of hydration status cannot be excluded, even under carefully standardised measurement conditions in line with ESPEN recommendations [19,47,48]. Regarding lipid parameters, a significant improvement was observed for triglycerides. Meta-analytic evidence indicates that weight reduction is one of the key factors associated with lowering triglyceride levels [49]. The absence of significant changes in total cholesterol and LDL-C may be related to concomitant use of lipid-lowering therapy, which could have limited the potential to detect additional intervention effects. Finally, it is worth highlighting the group-based structure of the intervention. Participants took part in group education delivered by an MDT including a GP/diabetologist, a dietitian, a psychologist, and a nurse. Evidence comparing individual and group education in people with T2DM suggests that group-based approaches can yield favourable outcomes, including improvements in HbA1c, body weight, waist circumference, triglycerides, and diabetes related knowledge. Moreover, interventions delivered with a group component have more often been associated with greater HbA1c improvement than those implemented without peer-group support [50,51]. At the same time, available evidence indicates that effects may be stronger when CGM is combined with behavioural or educational interventions, resulting in greater improvements in glycaemic and psychosocial outcomes than CGM alone or education alone [52]. Similarly, combining diabetes self-management education and support (DSMES) with intermittently scanned CGM (isCGM) has been associated with a larger reduction in HbA1c compared with DSMES alone [53]. Taken together, these findings suggest that periodic use of CGM as an adjunct to group-based education may enhance the effectiveness of lifestyle-focused interventions. This study has several limitations. The lack of randomisation and the small sample size limit the generalisability of the findings. In addition, outcomes were compared between participants using CGM and SMBG without a parallel control group receiving usual care, which makes it difficult to attribute the observed changes solely to the intervention. Another limitation is the 6-month follow-up, which does not allow assessment of the durability of the effects, while long-term maintenance of lifestyle changes is crucial for sustained success. Finally, body composition assessed by BIA, although standardised, remains sensitive to changes in hydration status, which may affect the accuracy of FFM estimates. Given the growing interest in lifestyle interventions in the care of people with type 2 diabetes, further studies with larger sample sizes are warranted. 5. Conclusion These findings suggest that a structured, group-based lifestyle programme delivered by an MDT can be implemented in routine care for people with type 2 diabetes in Poland and may lead to clinically meaningful improvements in glycaemic control and body weight. Greater reductions in weight and BMI among CGM users indicate that intermittent CGM, when integrated into structured education, may provide additional benefit. Declarations Acknowledgements CARE4DIABETES consortium (alphabetical order): Agapiou María, Aittola Kirsikka, Anjos Madalena, Dziklińska Patrycja , Balasopoulou Anastasia, Ballová Natália, Becherini Benedetta, Borg Buontempo Mariella, Brunec Anja, Bulzomi Rocco, Burgaz Celia, Busuttil Glorianne, Ceccarelli Anna, Csizmadia Péter, Diankova Snejanka, Do Ó Dulce, Do Vale Sonia, Dourou Ioanna, Drakopoulou Evaggelia, Escribano-Santamarina María, Espino Isabel, Fatyga Emilia, Georgieva Silvia, González Paloma, Gonzalvez-Muñoz Ainhoa, Hasomeri Anastasia, Hristov Kristiyan, Jeznach-Steinhagen Anna , Kozłowski Rafał , Kirsikka Aittola, Kułaga Katarzyna , Lasilla-Cruz Lucía, Llaneza-Suárez Elvira, Madalena Anjos, Martínez-Brocca Mª Asunción, Milivoj Piletic, Merayo-Galbán Antonio, Motta Laura, Ochoa-González Raquel, Opresnik Denis, Ostrowska Joanna, Papadimitriou Konstantinos, Paraschou Eleni Maria, Parras Nuria, Peteh Claudia, Piaggesi Alberto, Pitocco Dario, Popovska Snezhana, Prieto-Santos Nuria, Psaltopoulou Theodora, Raposo João Filipe, Ravnachka Bianka, Ribeiro Rogério, Rodríguez-Acuña Rafael, Saarelainen Eeva, Sekuła Marzena , Senderáková Soňa, Silva Sónia, Sosnowska Maja , Stavroula Paschou, Suárez Silvia, Tabone-Trapani Denise, Tamburi Tania, Tase Iliya, TheocharidisTheodoros, Tiia Eho, Toczyłowska Klaudia , Tomé-Pérez Yolanda, Tyufekchieva Mariya, Valtanen Mikko, Valve Päivi, Vandevijvere Stefanie, Vassallo Paula, Vázquez- Salvi Luis Alberto, Viegas Ana, Wikström Katja, Zacharaki Panagiota, Zoran Katančić, Zouroudi Emmanouela. This study was supported by the European Union and HADEA and co-financed by the Polish Ministry of Science and Higher Education under the program "International Co-financed Projects". We would like to express our sincere appreciation to Martiatt Antoinette and Maria Vasile as Project Officers for the project implementation. We would also like to thank Rocío Allande, General Manager, for the institutional support she provides to the coordinating team from the General Directorate of Care and Socio-Health Coordination of the Ministry of Health of Asturias. Funding Funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or HADEA. Neither the European Union nor the granting authority can be held responsible for them. Project co-financed by the Polish Ministry of Science and Higher Education under the program "International Co-financed Projects". Author contributions J.O. conceived the concept of this manuscript, coordinated the Polish cohort analysis, contributed to study implementation and data collection, interpreted the data and drafted the manuscript. E.K. and M.P. contributed to data collection, study implementation, drafting of the manuscript, particularly the Discussion section, and critical revision of the manuscript. A.S. and K.W. contributed to data collection, study implementation and critical revision of the manuscript. M.M.P.-G. contributed to the overall conceptual framework of the CARE4DIABETES project, interpretation of the findings and critical revision of the manuscript. All authors reviewed the manuscript, approved the final version and agree to be accountable for all aspects of the work. Data availability statement The datasets analysed during the current study are not publicly available due to privacy and ethical restrictions related to participant-level clinical data but are available from the corresponding author on request. Additional Information Competing interests: The authors declare no competing interests References International Diabetes Federation. IDF Diabetes Atlas. 11th ed. International Diabetes Federation, Brussels Global Diabetes Data & Insights | IDF Diabetes Atlas. (2025). LeBlanc, E. S. et al. Behavioral and pharmacotherapy weight loss interventions to prevent obesity-related morbidity and mortality in adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 320 , 1172–1191. 10.1001/jama.2018.7777 (2018). ElSayed, N. A. et al. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes – 2023. Diabetes Care . 46 (Suppl 1), S10–S18. 10.2337/dc23-S001 (2023). The Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD). Evidence-based European recommendations for the dietary management of diabetes. Diabetologia 66 , 965–985. 10.1007/s00125-023-05894-8 (2023). Lingvay, I., Sumithran, P. & Cohen, R. V. le Roux, C. W. Obesity management as a primary treatment goal for type 2 diabetes: time to reframe the conversation. Lancet 399 , 394–405. 10.1016/S0140-6736(21)01919-X (2022). Araszkiewicz, A. et al. Standards of Care in Diabetes. The position of Diabetes Poland – 2025. Curr. Top. Diabet. 5 (1), 1–158. 10.5114/ctd/203685 (2025). Tu, Q. et al. The effects of multidisciplinary collaborative care on cardiovascular risk factors among patients with diabetes in primary care settings: A systematic review and meta-analysis. Prim. Care Diabetes . 18 , 381–392. 10.1016/j.pcd.2024.05.003 (2024). Mustapa, A., Justine, M. & Manaf, H. Effects of patient education on the quality of life of patients with type 2 diabetes mellitus: a scoping review. Malays Fam Physician . 17 (3), 22–32. 10.51866/rv.208 (2022). Steinsbekk, A. et al. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus: a systematic review with meta-analysis. BMC Health Serv. Res. 12 , 213. 10.1186/1472-6963-12-213 (2012). American Diabetes Association. Diabetes Technology: Standards of Care in Diabetes – 2025. Diabetes Care . 48 (Suppl 1), S146–S159. 10.2337/dc25-S007 (2025). Moschonis, G. et al. Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials. Lancet Digit. Health . 5 , e125–e143. 10.1016/S2589-7500(22)00233-3 (2023). Sherifali, D. et al. Effect of diabetes health coaching on glycemic control and quality of life in adults living with type 2 diabetes: a community-based, randomized, controlled trial. Can. J. Diabetes . 45 , 594–600. 10.1016/j.jcjd.2020.11.012 (2021). Pot, G. K. et al. Nutrition and lifestyle intervention in type 2 diabetes: pilot study in the Netherlands showing improved glucose control and reduction in glucose lowering medication. BMJ Nutr. Prev. Health . 2 , 43–50. 10.1136/bmjnph-2018-000012 (2019). Wilmsen, N., Pijl, H., Geerlings, W. & Navis, G. Retrospective analysis on the effect of Reverse Diabetes2 Now on kidney function in patients with type 2 diabetes with impaired kidney function. BMJ Nutr. Prev. Health . 5 , 271–276. 10.1136/bmjnph-2021-000397 (2022). Pot, G. K. et al. Observational study on dietary changes of participants following a multicomponent lifestyle program (Reverse Diabetes2 Now). J. Hum. Nutr. Diet. 35 , 791–803. 10.1111/jhn.12976 (2022). Pot, G. K. et al. Lifestyle medicine for type 2 diabetes: practice-based evidence for long-term efficacy of a multicomponent lifestyle intervention (Reverse Diabetes2 Now). BMJ Nutr. Prev. Health . 3 , 188–195. 10.1136/bmjnph-2020-000081 (2020). Diez-Valcarce, I. et al. Multidisciplinary lifestyle treatment for type 2 diabetes in 12 European countries: protocol for a quasi-experimental study. BMC Public. Health . 25 , 1069. 10.1186/s12889-025-22246-w (2025). De Vries, H. An integrated approach for understanding health behavior; the I-change model as an example. Psychol. Behav. Sci. Int. J. 2 (2), 555585. 10.19080/pbsij.2.2 (2017). Lochs, H. et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, definitions and general topics. Clin. Nutr. 25 , 180–186. 10.1016/j.clnu.2006.02.007 (2006). Sartore, G., Ragazzi, E., Caprino, R. & Lapolla, A. Long-term HbA1c variability and macro-/micro-vascular complications in type 2 diabetes mellitus: a meta-analysis update. Acta Diabetol. 60 (6), 721–738. 10.1007/s00592-023-02037-8 (2023). Wang, S. et al. Glycated haemoglobin variability and risk of renal function decline in type 2 diabetes mellitus: An updated systematic review and meta-analysis. Diabetes Obes. Metab. 26 (11), 5167–5182. 10.1111/dom.15861 (2024). Chew, S. M., Avinashi, D., Venkataraman, K. & S., & Predictors of incident diabetic peripheral neuropathy: a systematic review of longitudinal studies in patients with diabetes mellitus. Rev. Endocr. Metab. Disord . 26 (4), 659–677. 10.1007/s11154-025-09973-6 (2025). Lean, M. E. et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet (London England) . 391 (10120), 541–551. 10.1016/S0140-6736(17)33102-1 (2018). Hallberg, S. J. et al. Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: An open-label, non-randomized, controlled study. Diabetes Ther. 9 (2), 583–612. 10.1007/s13300-018-0386-4 (2018). Hanick, C. J., Peterson, C. M., Davis, B. C., Sabaté, J. & Kelly, J. H. Jr. A whole-food, plant-based intensive lifestyle intervention improves glycaemic control and reduces medications in individuals with type 2 diabetes: a randomised controlled trial. Diabetologia 68 (2), 308–319. 10.1007/s00125-024-06272-8 (2025). Fernandez-Alvarez, D. M., Papín-Cano, M., Surendran, C., Martin-Payo, R. & S., & Td2Ast project: A pragmatic intervention on diet and physical activity for patients with type 2 diabetes mellitus. Prim. Care Diabetes . 19 (3), 270–276. 10.1016/j.pcd.2025.02.003 (2025). Lin, C. L., Huang, L. C., Chang, Y. T., Chen, R. Y. & Yang, S. H. Effectiveness of health coaching in diabetes control and lifestyle improvement: A randomized-controlled trial. Nutrients 13 (11), 3878. 10.3390/nu13113878 (2021). Sukkarieh-Haraty, O. et al. Results from the first culturally tailored, multidisciplinary diabetes education in Lebanese adults with type 2 diabetes: effects on self-care and metabolic outcomes. BMC Res. Notes . 15 (1), 39. 10.1186/s13104-022-05937-0 (2022). Bannuru, R. R. et al. Continuous glucose monitoring to guide lifestyle choices with a focus on nutrition in the management of type 2 diabetes: A systematic review and meta-analysis. J. Diabetes Sci. Technol. 19322968251384318 10.1177/19322968251384318 (2025). Lind, N., Christensen, M. B., Hansen, D. L. & Nørgaard, K. Comparing continuous glucose monitoring and blood glucose monitoring in adults with inadequately controlled, insulin-treated type 2 diabetes (Steno2tech Study): A 12-month, single-center, randomized controlled trial. Diabetes Care . 47 (5), 881–889. 10.2337/dc23-2194 (2024). Ferreira, R. O. M. et al. Continuous glucose monitoring systems in noninsulin-treated people with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Diabetes Technol. Ther. 26 (4), 252–262 (2024). 0.1089/dia.2023.0390. Uhl, S., Choure, A., Rouse, B., Loblack, A. & Reaven, P. Effectiveness of continuous glucose monitoring on metrics of glycemic control in type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials. J. Clin. Endocrinol. Metab. 109 (4), 1119–1131. 10.1210/clinem/dgad652 (2024). Duijzer, G. et al. Effect and maintenance of the SLIMMER diabetes prevention lifestyle intervention in Dutch primary healthcare: a randomised controlled trial. Nutr. Diabetes . 7 (5), e268. 10.1038/nutd.2017.21 (2017). Franz, M. J., Boucher, J. L., Rutten-Ramos, S. & VanWormer, J. J. Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. J. Acad. Nutr. Diet. 115 (9), 1447–1463. 10.1016/j.jand.2015.02.031 (2015). Palmer, R. et al. Associations between decreases in adiposity and reductions in HbA1c and insulin use in the look AHEAD cohort. Obes. (Silver Spring Md) . 33 (3), 612–620. 10.1002/oby.24242 (2025). Shinde, S. et al. Impact of weight change on glycemic control and metabolic parameters in T2D: A retrospective US study based on real-world data. Diabetes 15 (2), 409–426. 10.1007/s13300-023-01511-4 (2024). Deng, L., Jia, L., Wu, X. L. & Cheng, M. Association between body mass index and glycemic control in type 2 diabetes mellitus: A cross-sectional study. Diabetes Metab. Syndr. Obes. 18 , 555–563. 10.2147/DMSO.S508365 (2025). Willis, H. J., Johnson, E. & JaKa, M. A nutrition-focused approach during continuous glucose monitoring initiation in people with type 2 diabetes: using a theoretical framework to unite continuous glucose monitoring and food choices. J. Diabetes Sci. Technol. 19 (5), 1400–1406. 10.1177/19322968241247559 (2025). Rosenfeld, R. M., Grega, M. L. & Gulati, M. Lifestyle interventions for treatment and remission of type 2 diabetes and prediabetes in adults: implications for clinicians. Am. J. Lifestyle Med. 15598276251325802 10.1177/15598276251325802 (2025). [48] Peng, M., Shen, P. & Kim, K. J. Effects of continuous glucose monitoring on physical activity and diet in diabetes: a systematic review and meta-analysis. Int. J. Behav. Nutr. Phys. Act. 23 (1), 14. 10.1186/s12966-025-01870-0 (2026). Richardson, K. M. et al. The efficacy of using continuous glucose monitoring as a behaviour change tool in populations with and without diabetes: a systematic review and meta-analysis of randomised controlled trials. Int. J. Behav. Nutr. Phys. Act. 21 (1), 145. 10.1186/s12966-024-01692-6 (2024). Griauzde, D. H. et al. Continuous glucose monitoring with low-carbohydrate nutritional coaching to improve type 2 diabetes control: randomized quality improvement program. J. Med. Internet Re . 24 (2), e31184. 10.2196/31184 (2022). Lowrie, F. J. et al. The impact of exercise on fat free mass reduction during very low energy diet-induced weight loss in adults with overweight or obesity: A systematic review and meta-analysis. Obes. Res. Clin. Pract. 19 (5), 380–387. 10.1016/j.orcp.2025.10.001 (2025). Feng, L. et al. Prevalence and risk factors of sarcopenia in patients with diabetes: A meta-analysis. J. Clin. Endocrinol. Metab. 107 (5), 1470–1483. 10.1210/clinem/dgab884 (2022). Wang, M. et al. Diabetes and sarcopenic obesity: pathogenesis, diagnosis, and treatments. Front. Endocrinol. (Lausanne) . 11 , 568. 10.3389/fendo.2020.00568 (2020). Izzo, A., Massimino, E., Riccardi, G. & Della Pepa, G. A narrative review on sarcopenia in type 2 diabetes mellitus: prevalence and associated factors. Nutrients 13 (1), 183. 10.3390/nu13010183 (2021). Kyle, U. G. et al. Bioelectrical impedance analysis - part I: review of principles and methods. Clin. Nutr. 23 , 1226–1243. 10.1016/j.clnu.2004.06.004 (2004). Deurenberg, P. et al. Changes in fat-free mass during weight loss measured by bioelectrical impedance and by densitometry. Am. J. Clin. Nutr. 49 , 33–36. 10.1093/ajcn/49.1.33 (1989). Hasan, B. et al. Weight loss and serum lipids in overweight and obese adults: A systematic review and meta-analysis. J. Clin. Endocrinol. Metab. 105 (12). 10.1210/clinem/dgaa673 (2020). Mannucci, E. et al. Self-management in patients with type 2 diabetes: Group-based versus individual education. A systematic review with meta-analysis of randomized trails. Nutrit Netab Cardiovasc. Dis. NMCD . 32 (2), 330–336. 10.1016/j.numecd.2021.10.005 (2022). Odgers-Jewell, K. et al. Effectiveness of group-based self-management education for individuals with type 2 diabetes: a systematic review with meta-analyses and meta-regression. Diabet. Med. 34 (8), 1027–1039. 10.1111/dme.13340 (2017). Park, Y. et al. Impact of real-time continuous glucose monitoring and personalized digital health coaching on glycemic control and lifestyle in patients with type 2 diabetes and prediabetes. Prim. Care Diabetes . 20 (1), 61–67. 10.1016/j.pcd.2025.12.002 (2026). Aronson, R. et al. Impact of flash glucose monitoring in people with type 2 diabetes inadequately controlled with non-insulin antihyperglycaemic therapy (IMMEDIATE): A randomized controlled trial. Diabetes Obes. Metab. 25 (4), 1024–1031. 10.1111/dom.14949 (2023). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 28 Apr, 2026 Reviews received at journal 26 Apr, 2026 Reviews received at journal 23 Apr, 2026 Reviews received at journal 19 Apr, 2026 Reviewers agreed at journal 15 Apr, 2026 Reviewers agreed at journal 14 Apr, 2026 Reviewers agreed at journal 13 Apr, 2026 Reviewers invited by journal 13 Apr, 2026 Editor assigned by journal 13 Apr, 2026 Editor invited by journal 25 Mar, 2026 Submission checks completed at journal 24 Mar, 2026 First submitted to journal 24 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9169658","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":625743865,"identity":"82bbddd1-ce3a-4fd1-b597-8c7454520326","order_by":0,"name":"Joanna Ostrowska","email":"data:image/png;base64,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","orcid":"","institution":"Medical University of Warsaw","correspondingAuthor":true,"prefix":"","firstName":"Joanna","middleName":"","lastName":"Ostrowska","suffix":""},{"id":625743868,"identity":"8ad63e78-7ba4-4c8a-b50a-c03b48d9398d","order_by":1,"name":"Ewa Kobos","email":"","orcid":"","institution":"Medical University of Warsaw","correspondingAuthor":false,"prefix":"","firstName":"Ewa","middleName":"","lastName":"Kobos","suffix":""},{"id":625743874,"identity":"1fcc96ba-0bf7-4c7f-aa0c-f7eaf36bc479","order_by":2,"name":"Mariola Pietrzak","email":"","orcid":"","institution":"Medical University of Warsaw","correspondingAuthor":false,"prefix":"","firstName":"Mariola","middleName":"","lastName":"Pietrzak","suffix":""},{"id":625743879,"identity":"d2fd7f36-0ad7-4918-8d51-a19719afdb12","order_by":3,"name":"Agata Szymczak","email":"","orcid":"","institution":"National Health Fund Headquarters","correspondingAuthor":false,"prefix":"","firstName":"Agata","middleName":"","lastName":"Szymczak","suffix":""},{"id":625743890,"identity":"c472025c-0994-4d39-b251-ae437e1ca69f","order_by":4,"name":"Katarzyna Wiktorzak","email":"","orcid":"","institution":"National Health Fund Headquarters","correspondingAuthor":false,"prefix":"","firstName":"Katarzyna","middleName":"","lastName":"Wiktorzak","suffix":""},{"id":625743891,"identity":"c723d478-eed7-44b8-9d8a-1276612ba41b","order_by":5,"name":"Marta M. Pisano-González","email":"","orcid":"","institution":"Ministry of Health of the Principality of Asturias (CSPA)","correspondingAuthor":false,"prefix":"","firstName":"Marta","middleName":"M.","lastName":"Pisano-González","suffix":""}],"badges":[],"createdAt":"2026-03-19 12:53:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9169658/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9169658/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107419487,"identity":"2e743a2f-b808-4d52-b32b-e0c6ff8574b1","added_by":"auto","created_at":"2026-04-21 10:14:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":874683,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9169658/v1/f9de5058-24b9-4dfc-b5dc-1ee037b9b6d8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Lifestyle intervention outcomes in T2DM and the added value of CGM: 6-month results from the Polish cohort of the C4D study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eType 2 diabetes (T2DM) is the most common form of diabetes, accounting for over 90% of cases worldwide, and its prevalence continues to rise [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Evidence consistently shows that weight reduction and long-term weight maintenance, achieved through appropriate dietary changes and increased physical activity, are central to the management of T2DM. Such lifestyle changes improve glycaemic control and other major cardiometabolic risk factors, including blood pressure, lipid profile, and inflammatory status [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs a chronic condition, T2DM requires daily self-management, regular monitoring of metabolic parameters, and numerous decisions made in everyday life. For this reason, patient education is a cornerstone of effective care and has long been recognised as a standard component of diabetes management. Recent recommendations from the European Association for the Study of Diabetes (EASD) and the Diabetes Nutrition Study Group (DNSG) underline the value of long-term, structured education programmes delivered by multidisciplinary teams (MDT) and grounded in behavioural therapy, as these approaches help patients understand and implement sustainable health behaviours and thereby support durable weight loss [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Importantly, clinically meaningful and sustained weight loss may allow dose reduction of glucose-lowering medication and, in some individuals, contribute to T2DM remission [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The Polish Diabetes Association (PTD) also recommends that structured education and ongoing re-education should be available to all people with T2DM and their carers and emphasises delivery by a qualified MDT [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEducation can be delivered individually or in groups, in-person, remotely, or in hybrid formats, with possible involvement of family members or carers. Group-based programmes led by MDTs have been linked to better metabolic outcomes, higher treatment satisfaction, and stronger motivation for lifestyle change [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Some studies suggest they may be at least as effective as individual education and, in certain settings, more effective in sustaining long term benefits [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Tele-education is also gaining importance through educational platforms and mobile applications, telephone and video consultations, webinars, e-learning, and SMS reminders [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Available evidence further suggests that tele-education may be comparable to traditional approaches and, in some analyses, was associated with a greater reduction in HbA1c (mean difference\u0026thinsp;\u0026minus;\u0026thinsp;0.3%; 95% CI: \u0026minus;0.42 to \u0026minus;\u0026thinsp;0.19) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWithin this context, continuous glucose monitoring (CGM) may further strengthen lifestyle education by providing detailed glucose profiles that help patients and clinicians link everyday behaviours (such as meals, physical activity, sleep, and stress) to glucose patterns. The most effective approaches are therefore likely to combine digital tools (including CGM) with structured education and behavioural support tailored to individual needs and capacities [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. An example of such an integrated model is CARE4DIABETES (C4D), a year-long structured lifestyle programme delivered within a Joint Action involving 30 partners from 12 European Union countries (Belgium, Bulgaria, Slovakia, Slovenia, Finland, Greece, Hungary, Italy, Malta, Poland, Portugal, and Spain as the consortium lead). C4D implemented an intensive, outpatient lifestyle education programme for people with T2DM to support active self-management. The intervention is based on the Dutch programme ReverseDiabetes2Now (developed by Voeding Leeft) [\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], which has been implemented in the Netherlands for a decade and was recognised by the European Union as a \u0026ldquo;best practice\u0026rdquo; before being piloted in participating countries, including Poland. According to data reported by Voeding Leeft, 92% of people with T2DM achieved metabolic control after 12 months of participation, allowing partial or complete discontinuation of pharmacotherapy [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The programme targets four core lifestyle domains: diet, physical activity, stress management, and sleep duration and quality, and differs from usual care through its group-based structure (approximately 20 participants per group), the intensity of delivery (six full-day sessions), and its strong emphasis on therapeutic lifestyle change, with diet as a central component.\u003c/p\u003e \u003cp\u003eIn this study, we addressed two questions. First, we assessed whether participation in a structured lifestyle intervention was associated with improvements in glycaemic control and body composition over 6 months in individuals with T2DM. Second, we evaluated whether adding CGM to the same programme was associated with greater improvements in metabolic outcomes compared with participation without CGM.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study design and setting\u003c/h2\u003e \u003cp\u003eCARE4DIABETES (C4D) is a 12-month, quasi-experimental study implemented across 12 European countries, adapted from the Dutch \u0026ldquo;Reverse Diabetes 2Now\u0026rdquo; best practice [\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The study methodology has been described in detail in the published protocol [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In brief, C4D is a 12-month, structured lifestyle programme for adults with type 2 diabetes (up to 10 years since diagnosis), delivered by a MDT through multiple group-based educational sessions covering four domains: nutrition, physical activity, sleep, and relaxation/stress management [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Participants and eligibility\u003c/h2\u003e \u003cp\u003eParticipants were adults with physician diagnosed T2DM recruited from a Polish primary care clinic. Eligible patients were invited by their general practitioners (GP), who also provided clinical follow-up during the programme.\u003c/p\u003e \u003cp\u003eInclusion criteria were in line with the C4D protocol [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]: adults aged 20\u0026ndash;80 years with type 2 diabetes of 1\u0026ndash;10 years\u0026rsquo; duration, a BMI of 25\u0026ndash;40 kg/m\u0026sup2;, and pharmacological treatment (oral and/or injectable agents, including insulin). Use of GLP-1 receptor agonists or SGLT-2 inhibitors required a minimum of 6 months on a stable dose/regimen prior to programme start. Further eligibility requirements included the absence of major contraindications to participation (e.g., COPD, heart failure, severe renal impairment defined as eGFR\u0026thinsp;\u0026lt;\u0026thinsp;30 mL/min/1.73 m\u0026sup2;, prior bariatric surgery, eating disorders, or pregnancy), willingness to engage in lifestyle change, adequate language proficiency, access to and ability to use an internet-enabled device, and willingness to perform home blood glucose monitoring.\u003c/p\u003e \u003cp\u003eIn Poland, 38 participants were enrolled. All participants took part in the same structured lifestyle intervention, delivered through educational sessions in two cohorts of similar size. The cohorts differed only in the glucose monitoring method used: one cohort used CGM (n\u0026thinsp;=\u0026thinsp;21), whereas the other used standard SMBG with a glucometer (n\u0026thinsp;=\u0026thinsp;17), in line with instructions provided by the physician and nurse within the MDT.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Intervention\u003c/h2\u003e \u003cp\u003eC4D is a structured education programme grounded in behavioural change principles (I-Change model) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and designed to help participants practise and integrate new habits rather than only receive information. The programme lasts 12 months and includes two consecutive stages: (I) a 6-month intensive training phase and (II) a 6-month aftercare phase. The 6-month intensive phase consisted of six full-day, structured group sessions delivered by the MDT (GP/diabetologist, dietitian, psychologist, and nurse) and focused on key behavioural therapy components: diet, physical activity, stress coping, and healthy sleep.\u003c/p\u003e \u003cp\u003eIn Poland, sessions were delivered in a hybrid format: four face-to-face workshops and two remote (telematic) workshops. Workshops took place at programme start (kick-off meeting with an overnight stay), and then at months 1 (remote), 3 (face-to-face), 4.5 (remote), and 6 (face-to-face). A distinctive feature of the in-person component was an overnight kick-off meeting. The aim was to build group cohesion and encourage early engagement by removing participants from their usual routines, reducing exposure to triggers (e.g., habitual snacking), and providing an added layer of support (particularly for those using medications associated with hypoglycaemia).\u003c/p\u003e \u003cp\u003eKey components of the intervention are described in the published protocol [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In brief, the programme combines education with practical activities. Sessions covered healthy eating principles, meal planning and preparation, cooking classes, food label reading, practical recipe modification, supervised physical exercises, relaxation techniques, and basic coaching practices. Behavioural support was embedded throughout, using group work and peer support to maintain motivation and facilitate adherence. Participants also received introductory education on T2DM pathophysiology, interpretation of daily glucose patterns, biometric feedback, and practical self-management strategies. The entire intervention was supported by a digital platform enabling peer interaction and contact with the MDT, facilitating ongoing coaching and medical monitoring. Throughout the programme, participants were supervised by the MDT, and medication adjustments were made when clinically indicated.\u003c/p\u003e \u003cp\u003eAs described above, one group used CGM, and the second group followed SMBG. In the CGM group, FreeStyle Libre 2 sensors (Abbott Diabetes Care) were applied according to a predefined schedule: two 14-day sensors at baseline, one 14-day sensor at 3 months, and one 14-day sensor at 6 months of the lifestyle intervention. Outside these CGM periods, participants measured capillary blood glucose using glucometers, following physician and nurse instructions provided by the physician and nurse within the MDT.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Data Collection\u003c/h2\u003e \u003cp\u003eClinical, anthropometric, and body composition measures were collected by the MDT using standardised procedures at baseline and at 6 months, in line with the protocol measurement schedule [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Although the protocol also includes an assessment at 12 months, the present paper reports interim outcomes for the Polish cohort based on baseline and 6-month data only.\u003c/p\u003e \u003cp\u003eBody weight and height were measured using a Seca 799 measuring station (column scale) with a precision of \u0026plusmn;\u0026thinsp;0.1 kg and \u0026plusmn;\u0026thinsp;0.1 cm, respectively. Waist circumference was measured using a steel tape positioned midway between the lower rib margin and the iliac crest, in the horizontal plane. Body composition was assessed using bioelectrical impedance analysis (BIA) with a multi-frequency segmental analyzer (Tanita MC-780MA, Tanita Corporation, Tokyo, Japan) following the manufacturer\u0026rsquo;s instructions. Participants were asked to follow the European Society for Clinical Nutrition and Metabolism (ESPEN) recommendations [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Specifically, they were instructed to fast for at least 2\u0026ndash;3 h before testing, avoid physical activity for 12 h, abstain from alcohol and caffeinated or carbonated beverages for 24 h, and empty their bladder 30 min prior to the assessment. Biochemical measurements included HbA1c (%), total cholesterol (mg/dL), HDL cholesterol (mg/dL), LDL cholesterol (mg/dL), and triglycerides (mg/dL).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Statistical analysis\u003c/h2\u003e \u003cp\u003eAnalyses were performed in participants with paired measurements at baseline and 6 months. Continuous variables are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. Within-participant changes were evaluated using paired t-tests; normality of the change scores was assessed (Shapiro\u0026ndash;Wilk test), and when the normality assumption was not met, the Wilcoxon signed-rank test was used as a sensitivity analysis. Two-sided p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant. Effect sizes were quantified using Cohen\u0026rsquo;s d for paired data, and 95% confidence intervals for mean changes were calculated using the t distribution. Participants were additionally stratified by glucose monitoring method (CGM vs SMBG). Between group differences in baseline to 6-month change scores (ΔCGM vs ΔSMBG) were evaluated using an independent-samples t-test; when distributional assumptions were not met, the Mann\u0026ndash;Whitney U test was used as a sensitivity analysis. Between-group effect sizes were expressed as Cohen\u0026rsquo;s d for independent groups (based on change scores) and interpreted as small (|d| \u0026lt; 0.2), medium (0.2 \u0026le; |d| \u0026lt; 0.5), large (0.5 \u0026le; |d| \u0026lt; 0.8), and very large (|d| \u0026ge; 0.8). Because multiple outcomes were analysed, p-values were interpreted descriptively without adjustment for multiple comparisons.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6. Ethics\u003c/h2\u003e \u003cp\u003e The Polish implementation received approval from the Bioethics Committee at the Medical University of Warsaw (No. KB/270/2023, 13 November 2023). All methods were performed in accordance with relevant guidelines and regulations, and the study was conducted in accordance with the Declaration of Helsinki. All participants received a participant information sheet and provided written informed consent prior to participation.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eA total of 38 participants were included in the baseline analysis (CGM, n = 21; SMBG, n = 17). The cohort was predominantly female (63.2%), with a mean age of 56.13 \u0026plusmn; 11.17 years. At baseline, mean body weight was 95.45 \u0026plusmn; 16.61 kg and mean BMI was 32.06 \u0026plusmn; 4.73 kg/m\u0026sup2;, corresponding to obesity on average, while mean waist circumference was 106.71 \u0026plusmn; 10.97 cm, indicating substantial central adiposity. Mean HbA1c was 7.20 \u0026plusmn; 1.67% - above commonly used glycaemic targets for adults with type 2 diabetes. Lipid parameters were as follows: total cholesterol 179.45 \u0026plusmn; 39.76 mg/dl, HDL cholesterol 47.17 \u0026plusmn; 11.36 mg/dl, LDL cholesterol 104.38 \u0026plusmn; 37.55 mg/dl, and triglycerides 163.68 \u0026plusmn; 78.95 mg/dl. Baseline anthropometric, body composition and metabolic characteristics for the total sample and by subgroup are summarised in Table 1. Descriptively, the CGM group tended to have higher adiposity and higher HbA1c than the SMBG group, while lipid values were broadly similar between groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e Baseline characteristics of the study group (n=38)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.027%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9865%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll (Baseline)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(M \u0026plusmn; SD / n (%))\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1959%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCGM (Baseline)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(M \u0026plusmn; SD / n (%))\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7905%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSMBG (Baseline)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(M \u0026plusmn; SD / n (%))\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.027%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9865%;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1959%;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7905%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.027%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex: female, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9865%;\"\u003e\n \u003cp\u003e24 (63.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1959%;\"\u003e\n \u003cp\u003e14 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7905%;\"\u003e\n \u003cp\u003e10 (58.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.027%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex: male, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9865%;\"\u003e\n \u003cp\u003e14 (36.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1959%;\"\u003e\n \u003cp\u003e7 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7905%;\"\u003e\n \u003cp\u003e7 (41.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.027%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9865%;\"\u003e\n \u003cp\u003e56.13 \u0026plusmn; 11.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1959%;\"\u003e\n \u003cp\u003e57.0 \u0026plusmn; 12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7905%;\"\u003e\n \u003cp\u003e55.06 \u0026plusmn; 10.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.027%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBody weight (kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9865%;\"\u003e\n \u003cp\u003e95.45 \u0026plusmn; 16.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1959%;\"\u003e\n \u003cp\u003e101.39 \u0026plusmn; 17.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7905%;\"\u003e\n \u003cp\u003e88.12 \u0026plusmn; 11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.027%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeight (m)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9865%;\"\u003e\n \u003cp\u003e1.7 \u0026plusmn; 0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1959%;\"\u003e\n \u003cp\u003e1.71 \u0026plusmn; 0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7905%;\"\u003e\n \u003cp\u003e1.69 \u0026plusmn; 0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.027%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (kg/m\u0026sup2;)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9865%;\"\u003e\n \u003cp\u003e32.06 \u0026plusmn; 4.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1959%;\"\u003e\n \u003cp\u003e33.55 \u0026plusmn; 5.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7905%;\"\u003e\n \u003cp\u003e30.93 \u0026plusmn; 3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.027%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWaist circumference (cm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9865%;\"\u003e\n \u003cp\u003e106.71 \u0026plusmn; 10.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1959%;\"\u003e\n \u003cp\u003e108.95 \u0026plusmn; 11.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7905%;\"\u003e\n \u003cp\u003e103.94 \u0026plusmn; 9.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.027%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFat mass (kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9865%;\"\u003e\n \u003cp\u003e36.21 \u0026plusmn; 11.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1959%;\"\u003e\n \u003cp\u003e39.63 \u0026plusmn; 11.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7905%;\"\u003e\n \u003cp\u003e31.98 \u0026plusmn; 9.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.027%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVisceral fat\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9865%;\"\u003e\n \u003cp\u003e13.39 \u0026plusmn; 4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1959%;\"\u003e\n \u003cp\u003e14.71 \u0026plusmn; 4.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7905%;\"\u003e\n \u003cp\u003e11.76 \u0026plusmn; 3.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.027%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFFM (kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9865%;\"\u003e\n \u003cp\u003e60.1 \u0026plusmn; 11.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1959%;\"\u003e\n \u003cp\u003e61.66 \u0026plusmn; 11.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7905%;\"\u003e\n \u003cp\u003e58.17 \u0026plusmn; 9.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.027%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMuscle mass (kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9865%;\"\u003e\n \u003cp\u003e57.09 \u0026plusmn; 10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1959%;\"\u003e\n \u003cp\u003e58.57 \u0026plusmn; 11.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7905%;\"\u003e\n \u003cp\u003e55.26 \u0026plusmn; 9.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.027%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal body water\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9865%;\"\u003e\n \u003cp\u003e44.59 \u0026plusmn; 6.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1959%;\"\u003e\n \u003cp\u003e44.49 \u0026plusmn; 5.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7905%;\"\u003e\n \u003cp\u003e44.72 \u0026plusmn; 6.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.027%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHbA1c (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9865%;\"\u003e\n \u003cp\u003e7.2 \u0026plusmn; 1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1959%;\"\u003e\n \u003cp\u003e7.67 \u0026plusmn; 1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7905%;\"\u003e\n \u003cp\u003e6.62 \u0026plusmn; 1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.027%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal cholesterol (mg/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9865%;\"\u003e\n \u003cp\u003e179.45 \u0026plusmn; 39.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1959%;\"\u003e\n \u003cp\u003e176.33 \u0026plusmn; 40.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7905%;\"\u003e\n \u003cp\u003e183.29 \u0026plusmn; 39.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.027%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHDL cholesterol (mg/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9865%;\"\u003e\n \u003cp\u003e47.17 \u0026plusmn; 11.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1959%;\"\u003e\n \u003cp\u003e46.59 \u0026plusmn; 9.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7905%;\"\u003e\n \u003cp\u003e47.88 \u0026plusmn; 13.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.027%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLDL cholesterol (mg/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9865%;\"\u003e\n \u003cp\u003e104.38 \u0026plusmn; 37.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1959%;\"\u003e\n \u003cp\u003e100.88 \u0026plusmn; 40.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7905%;\"\u003e\n \u003cp\u003e108.71 \u0026plusmn; 34.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27.027%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTriglycerides (mg/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9865%;\"\u003e\n \u003cp\u003e163.68 \u0026plusmn; 78.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1959%;\"\u003e\n \u003cp\u003e149.19 \u0026plusmn; 56.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.7905%;\"\u003e\n \u003cp\u003e181.59 \u0026plusmn; 98.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e M \u0026ndash; mean; SD \u0026ndash; standard deviation; HbA1c \u0026ndash; glycated hemoglobin; BMI \u0026ndash; body mass index; FFM \u0026ndash; fat-free mass; LDL \u0026ndash; low-density lipoprotein cholesterol; HDL \u0026ndash; high-density lipoprotein cholesterol; SMBG - self-monitoring of blood glucose; CGM - continuous glucose monitoring\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOut of the 38 participants enrolled in Poland, 31 completed the 6-month intensive phase and had paired baseline and 6-month data available for analysis. After 6 months, glycaemic control improved significantly: mean HbA1c decreased from 7.13% to 6.35% (mean change \u0026minus;0.78 percentage points; p \u0026lt; 0.001; large effect). In parallel, participants achieved clinically meaningful reductions in anthropometric outcomes, with an average weight loss of 6.0 kg and a waist circumference reduction of 6.8 cm (both p \u0026lt; 0.001), alongside a significant decrease in BMI (\u0026minus;2.11 kg/m\u0026sup2;; p \u0026lt; 0.001; very large effects for weight-related outcomes).\u003c/p\u003e\n\u003cp\u003eBody composition analyses indicated a significant decrease in fat mass (\u0026minus;2.47 kg; p \u0026lt; 0.001) and a reduction in visceral fat (\u0026minus;0.93; p = 0.001). However, reductions were also observed in fat-free mass (\u0026minus;1.89 kg) and estimated muscle mass (\u0026minus;2.19 kg) (both p \u0026lt; 0.001), suggesting that weight loss was accompanied by losses in lean tissue. Total body water percentage did not change significantly (p = 0.153). In the lipid profile, triglycerides decreased significantly (\u0026minus;34.9 mg/dL; p = 0.023), whereas changes in total cholesterol and LDL cholesterol were modest and did not reach statistical significance; HDL cholesterol remained stable. Detailed results are presented in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e Changes in metabolic and anthropometric parameters after 6-month lifestyle intervention (n=31)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7152%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline (M \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.43709%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6-month (M \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0993%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange (M \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.60927%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI for Change\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.76821%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.45033%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.29801%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSig.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94702%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCohen\u0026apos;s d\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7152%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHbA1c (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e7.13 \u0026plusmn; 1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.43709%;\"\u003e\n \u003cp\u003e6.35 \u0026plusmn; 1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0993%;\"\u003e\n \u003cp\u003e-0.78 \u0026plusmn; 1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.60927%;\"\u003e\n \u003cp\u003e(-1.17, -0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.76821%;\"\u003e\n \u003cp\u003e-10.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.45033%;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.29801%;\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94702%;\"\u003e\n \u003cp\u003e-0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003elarge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7152%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBody weight (kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e92.89 \u0026plusmn; 15.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.43709%;\"\u003e\n \u003cp\u003e86.85 \u0026plusmn; 14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0993%;\"\u003e\n \u003cp\u003e-6.04 \u0026plusmn; 4.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.60927%;\"\u003e\n \u003cp\u003e(-7.76, -4.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.76821%;\"\u003e\n \u003cp\u003e-6.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.45033%;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.29801%;\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94702%;\"\u003e\n \u003cp\u003e-1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003every large\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7152%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (kg/m\u0026sup2;)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e32.06 \u0026plusmn; 4.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.43709%;\"\u003e\n \u003cp\u003e29.94 \u0026plusmn; 3.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0993%;\"\u003e\n \u003cp\u003e-2.11 \u0026plusmn; 1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.60927%;\"\u003e\n \u003cp\u003e(-2.72, -1.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.76821%;\"\u003e\n \u003cp\u003e-6.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.45033%;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.29801%;\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94702%;\"\u003e\n \u003cp\u003e-1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003every large\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7152%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWaist circumference (cm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e105.74 \u0026plusmn; 10.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.43709%;\"\u003e\n \u003cp\u003e98.97 \u0026plusmn; 9.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0993%;\"\u003e\n \u003cp\u003e-6.77 \u0026plusmn; 4.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.60927%;\"\u003e\n \u003cp\u003e(-8.43, -5.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.76821%;\"\u003e\n \u003cp\u003e-6.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.45033%;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.29801%;\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94702%;\"\u003e\n \u003cp\u003e-1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003every large\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.7152%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFat mass (kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e34.44 \u0026plusmn; 10.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.43709%;\"\u003e\n \u003cp\u003e31.97 \u0026plusmn; 9.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0993%;\"\u003e\n \u003cp\u003e\u0026ndash;2.47 \u0026plusmn; 3.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.60927%;\"\u003e\n \u003cp\u003e(-3.62, -1.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.76821%;\"\u003e\n \u003cp\u003e\u0026ndash;7.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.45033%;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.29801%;\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.94702%;\"\u003e\n \u003cp\u003e\u0026ndash;0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003every large\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7152%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVisceral fat\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e13.45 \u0026plusmn; 4.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.43709%;\"\u003e\n \u003cp\u003e12.52 \u0026plusmn; 4.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0993%;\"\u003e\n \u003cp\u003e-0.93 \u0026plusmn; 1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.60927%;\"\u003e\n \u003cp\u003e(-1.47, -0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.76821%;\"\u003e\n \u003cp\u003e-6.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.45033%;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.29801%;\"\u003e\n \u003cp\u003e**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94702%;\"\u003e\n \u003cp\u003e-0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003elarge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.7152%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFFM (kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e59.50 \u0026plusmn; 11.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.43709%;\"\u003e\n \u003cp\u003e57.61 \u0026plusmn; 11.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0993%;\"\u003e\n \u003cp\u003e\u0026ndash;1.89 \u0026plusmn; 2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.60927%;\"\u003e\n \u003cp\u003e(-2.67, -1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.76821%;\"\u003e\n \u003cp\u003e\u0026ndash;3.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.45033%;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.29801%;\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.94702%;\"\u003e\n \u003cp\u003e\u0026ndash;0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003every large\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.7152%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMuscle mass (kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e56.52 \u0026plusmn; 10.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.43709%;\"\u003e\n \u003cp\u003e54.33 \u0026plusmn; 11.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0993%;\"\u003e\n \u003cp\u003e\u0026ndash;2.19 \u0026plusmn; 2.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.60927%;\"\u003e\n \u003cp\u003e(-3.21, -1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.76821%;\"\u003e\n \u003cp\u003e\u0026ndash;3.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.45033%;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.29801%;\"\u003e\n \u003cp\u003e***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.94702%;\"\u003e\n \u003cp\u003e\u0026ndash;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003every large\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17.7152%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal body water (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e44.65 \u0026plusmn; 5.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.43709%;\"\u003e\n \u003cp\u003e45.49 \u0026plusmn; 5.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.0993%;\"\u003e\n \u003cp\u003e0.84 \u0026plusmn; 3.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.60927%;\"\u003e\n \u003cp\u003e(-0.33, 2.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.76821%;\"\u003e\n \u003cp\u003e+1.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.45033%;\"\u003e\n \u003cp\u003e0.153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.29801%;\"\u003e\n \u003cp\u003ens\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.94702%;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.4172%;\"\u003e\n \u003cp\u003emedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7152%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTriglycerides (mg/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e171.48 \u0026plusmn; 82.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.43709%;\"\u003e\n \u003cp\u003e136.61 \u0026plusmn; 56.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0993%;\"\u003e\n \u003cp\u003e-34.87 \u0026plusmn; 80.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.60927%;\"\u003e\n \u003cp\u003e(-64.57, -5.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.76821%;\"\u003e\n \u003cp\u003e-20.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.45033%;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.29801%;\"\u003e\n \u003cp\u003e*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94702%;\"\u003e\n \u003cp\u003e-0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003emedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7152%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal cholesterol (mg/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e176.1 \u0026plusmn; 39.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.43709%;\"\u003e\n \u003cp\u003e167.03 \u0026plusmn; 46.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0993%;\"\u003e\n \u003cp\u003e-9.06 \u0026plusmn; 26.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.60927%;\"\u003e\n \u003cp\u003e(-18.83, 0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.76821%;\"\u003e\n \u003cp\u003e-5.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.45033%;\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.29801%;\"\u003e\n \u003cp\u003ens\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94702%;\"\u003e\n \u003cp\u003e-0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003emedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7152%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLDL cholesterol (mg/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e100.75 \u0026plusmn; 40.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.43709%;\"\u003e\n \u003cp\u003e94.69 \u0026plusmn; 39.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0993%;\"\u003e\n \u003cp\u003e-6.06 \u0026plusmn; 24.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.60927%;\"\u003e\n \u003cp\u003e(-15.12, 3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.76821%;\"\u003e\n \u003cp\u003e-6.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.45033%;\"\u003e\n \u003cp\u003e0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.29801%;\"\u003e\n \u003cp\u003ens\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94702%;\"\u003e\n \u003cp\u003e-0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003emedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.7152%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHDL cholesterol (mg/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.2583%;\"\u003e\n \u003cp\u003e46.59 \u0026plusmn; 11.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.43709%;\"\u003e\n \u003cp\u003e46.16 \u0026plusmn; 10.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.0993%;\"\u003e\n \u003cp\u003e-0.43 \u0026plusmn; 7.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.60927%;\"\u003e\n \u003cp\u003e(-3.03, 2.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.76821%;\"\u003e\n \u003cp\u003e-0.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.45033%;\"\u003e\n \u003cp\u003e0.736\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.29801%;\"\u003e\n \u003cp\u003ens\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94702%;\"\u003e\n \u003cp\u003e-0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.4172%;\"\u003e\n \u003cp\u003esmall\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e M \u0026ndash; mean; SD \u0026ndash; standard deviation; 95% CI \u0026ndash; 95% confidence interval; HbA1c \u0026ndash; glycated hemoglobin; BMI \u0026ndash; body mass index; FFM \u0026ndash; fat-free mass; LDL \u0026ndash; low-density lipoprotein cholesterol; HDL \u0026ndash; high-density lipoprotein cholesterol; ns \u0026ndash; not significant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e* p \u0026lt; 0.05; ** p \u0026lt; 0.01; *** p \u0026lt; 0.001.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3 summarizes changes in metabolic and anthropometric parameters after 6 months in 31 participants who completed a 6‑month group-based structured educational programme, stratified into two groups: participants using CGM (n=17) and participants using SMBG (n=14).\u0026nbsp;Overall, both groups showed improvements in metabolic control and reductions in weight-related measures. The largest between-group differences were observed for body weight and BMI, with greater reductions in the CGM group compared with the SMBG group (between-group comparison of change significant for both outcomes). For most other outcomes (including HbA1c, waist circumference, lipid profile, and body composition measures), changes were generally favourable in both groups; however, between-group differences were smaller and mostly did not reach statistical significance, and effect sizes ranged from small to very large depending on the outcome. Notably, changes were generally more pronounced in the CGM group than in the SMBG group, although this pattern was not consistent for all lipid outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e Changes in metabolic and anthropometric parameters after 6 months (CGM n= 17 vs SMBG n=14)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCGM Baseline (M \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCGM 6 mo (M \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026Delta; CGM (p-value)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSMBG\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eBaseline (M \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSMBG\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e6 mo (M \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026Delta; SMBG\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(p-value)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value (between groups)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCohen\u0026apos;s d\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEffect Size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHbA1c (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.6 \u0026plusmn; 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.6 \u0026plusmn; 1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.0 \u0026plusmn; 1.1 **\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.6 \u0026plusmn; 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.0 \u0026plusmn; 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.6 \u0026plusmn; 1.0 ns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBody weight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e98.6 \u0026plusmn; 16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e90.6 \u0026plusmn; 14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-7.9 \u0026plusmn; 4.1 ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e86.0 \u0026plusmn; 11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e82.2 \u0026plusmn; 13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-3.8 \u0026plusmn; 4.5 **\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.012 *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eVery large\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33.6 \u0026plusmn; 4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30.8 \u0026plusmn; 3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-2.7 \u0026plusmn; 1.5 ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30.2 \u0026plusmn; 2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28.8 \u0026plusmn; 3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.4 \u0026plusmn; 1.6 **\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.019 *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eVery large\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWaist circumference (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e108.4 \u0026plusmn; 10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e101.0 \u0026plusmn; 8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-7.4 \u0026plusmn; 4.1 ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e102.5 \u0026plusmn; 10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e96.5 \u0026plusmn; 9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-6.0 \u0026plusmn; 5.0 ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFat mass (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38.4 \u0026plusmn; 10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35.8 \u0026plusmn; 9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-2.6 \u0026plusmn; 3.2 **\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30.2 \u0026plusmn; 9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.8 \u0026plusmn; 8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-2.4 \u0026plusmn; 3.0 *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.884\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSmall\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eVisceral fat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.1 \u0026plusmn; 3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.9 \u0026plusmn; 3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.3 \u0026plusmn; 1.6 ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.6 \u0026plusmn; 3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.1 \u0026plusmn; 3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.6 \u0026plusmn; 1.1 ns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLarge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFFM (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e61.6 \u0026plusmn; 12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e59.2 \u0026plusmn; 12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-2.4 \u0026plusmn; 1.9 ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e57.2 \u0026plusmn; 10.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55.9 \u0026plusmn; 11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.3 \u0026plusmn; 2.1 *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLarge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMuscle mass (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e58.5 \u0026plusmn; 11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e56.2 \u0026plusmn; 11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-2.3 \u0026plusmn; 1.9 ***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e54.4 \u0026plusmn; 9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e52.3 \u0026plusmn; 11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-2.0 \u0026plusmn; 3.4 *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.782\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSmall\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTriglycerides (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e152.6 \u0026plusmn; 56.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e139.1 \u0026plusmn; 54.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-13.6 \u0026plusmn; 60.5 ns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e194.4 \u0026plusmn; 102.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e133.6 \u0026plusmn; 61.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-60.7 \u0026plusmn; 96.5 *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLarge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTotal cholesterol (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e168.8 \u0026plusmn; 38.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e156.4 \u0026plusmn; 43.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-12.4 \u0026plusmn; 17.4 **\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e184.9 \u0026plusmn; 40.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e179.9 \u0026plusmn; 48.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-5.0 \u0026plusmn; 35.1 ns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.450\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLDL cholesterol (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e93.5 \u0026plusmn; 42.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85.1 \u0026plusmn; 36.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-8.4 \u0026plusmn; 17.0 ns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e109.6 \u0026plusmn; 36.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e106.4 \u0026plusmn; 39.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-3.2 \u0026plusmn; 32.2 ns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.565\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHDL cholesterol (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45.3 \u0026plusmn; 10.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45.8 \u0026plusmn; 10.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.5 \u0026plusmn; 7.2 ns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e48.1 \u0026plusmn; 13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e46.6 \u0026plusmn; 11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-1.6 \u0026plusmn; 7.0 ns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.428\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMedium\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e M \u0026ndash; mean; SD \u0026ndash; standard deviation; HbA1c \u0026ndash; glycated hemoglobin; BMI \u0026ndash; body mass index; FFM \u0026ndash; fat-free mass; LDL \u0026ndash; low-density lipoprotein cholesterol; HDL \u0026ndash; high-density lipoprotein cholesterol; ns \u0026ndash; not significant; SMBG - self-monitoring of blood glucose; CGM - continuous glucose monitoring\u003c/p\u003e\n\u003cp\u003ep \u0026lt; 0.05; ** p \u0026lt; 0.01; *** p \u0026lt; 0.001.\u0026nbsp;\u003c/p\u003e"},{"header":"4.\tDiscussion","content":"\u003cp\u003eThis study evaluated a 6-month lifestyle intervention in individuals with T2DM, with analyses stratified by glucose monitoring method (CGM vs. glucometer-based SMBG). At baseline, the study population had a mean BMI in the obese range and a mean HbA1c level above the general therapeutic target for T2DM recommended by the Polish Diabetes Association (PTD) [6]. After 6 months of participation in the C4D programme, glycaemic control improved in a statistically significant and clinically meaningful manner, as reflected by a reduction in mean HbA1c. HbA1c remains the key marker for assessing glycaemic control in type 2 diabetes and has a well-established predictive value for diabetes related complications [20\u0026ndash;22]. In the overall study group, HbA1c decreased by 0.78 percentage points to 6.35%, which is consistent with the general PTD treatment target of \u0026le;7% [6]. These results are consistent with evidence from other structured lifestyle programmes. The ReverseDiabetes2Now programme implemented in the Netherlands, which informed the design of C4D, also reported improvements in glycaemic outcomes [13]. Other lifestyle programmes have likewise reported marked metabolic benefits, including substantial weight loss, improved glycaemic control, and, in some cases, diabetes remission. In the DiRECT trial, 24% of participants lost at least 15 kg and 46% achieved remission at 12 months [23]. In the Virta Health programme, HbA1c decreased from 7.6% to 6.3% after 1 year, alongside a mean weight loss of 13.8 kg [24]. Further support comes from a lifestyle programme delivered in California (USA), where HbA1c decreased progressively over 24 weeks and remission was reported in 8% of participants [25]. Consistent reductions in HbA1c after 6 months of intervention have also been reported in studies conducted in Spain [26], Taiwan [27], and Lebanon [28].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOver 6 months, the reduction in HbA1c was larger in the CGM group than in the SMBG group, however, the between-group difference did not reach statistical significance, which may partly reflect the limited sample size. These findings align with available evidence suggesting that CGM can be a useful tool to support education and lifestyle decision making in T2DM, both in dietary interventions and in multicomponent lifestyle programmes, with potential benefits for glycaemic outcomes and body weight [29]. In the randomised Steno2Tech study, CGM use among insulin-treated individuals with type 2 diabetes was associated with greater improvements in time in range (TIR), HbA1c, and BMI compared with \u003cstrong\u003estandard glucometer-based SMBG\u003c/strong\u003e [30]. Improved glycaemic control has also been reported with CGM use in people with type 2 diabetes who are not treated with insulin [31,32]\u003c/p\u003e\n\u003cp\u003eThe study demonstrated significant reductions in body weight (approximately 6 kg on average), waist circumference (about 6.8 cm), and BMI (\u0026minus;2.11 kg/m\u0026sup2;) over the 6-month intervention period. These findings are consistent with results from other programmes combining dietary modification and physical activity, including the SLIMMER programme, where favourable changes in body weight, diet quality, and physical activity were shown to persist during follow-up after the intervention ended [33]. A weight loss of 5\u0026ndash;7% is generally considered clinically meaningful and is typically associated with improved glycaemic control [10,34]. Evidence from observational and interventional studies further suggests that greater reductions in adiposity, including body fat percentage, waist circumference, and BMI, may translate into larger improvements in HbA1c [35,36]. An association between higher BMI and poorer glycaemic control has also been reported in population-based analyses [37].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the subgroup analyses, greater reductions in body weight and BMI were observed among participants using CGM. It may be hypothesised that immediate feedback on glucose levels facilitated dietary adjustments and increased engagement in lifestyle change [10,38]. Diet and physical activity are central to maintaining glycaemic homeostasis, and CGM may strengthen patients\u0026rsquo; capacity for self-management by providing real-time feedback and helping to reduce glucose variability [39]. In line with this, a systematic review reported that, compared with control conditions, CGM use was associated with behavioural changes, including longer daily physical activity time and lower daily energy and carbohydrate intake [40]. Available evidence also suggests that, in people with type 2 diabetes, CGM can support tighter glycaemic control compared with SMBG [31], and CGM-based feedback has shown a moderate beneficial effect on glycaemic outcomes when used to support behaviour change in adults with and without diabetes [41]. By visualising glucose values as continuous curves, CGM can help patients understand the relationships between diet, physical activity, other lifestyle factors, and glycaemic outcomes, which may contribute to greater perceived self-efficacy in behaviour change [42].\u003c/p\u003e\n\u003cp\u003eIn this study, we observed significant reductions from baseline in both FFM and estimated muscle mass in participants using CGM as well as those using SMBG. Such changes may accompany weight loss, particularly when dietary protein intake is insufficient and resistance training is not performed regularly [43]. Epidemiological data indicate that the prevalence of sarcopenia is approximately threefold higher in people with diabetes than in those without diabetes, and in type 2 diabetes it has been estimated at around 18% [44]. Therefore, teams delivering lifestyle interventions should include an assessment of sarcopenia risk, particularly in older adults (in this study, the mean age was 65 years), in those with lower BMI (which in this context may reflect lower muscle mass reserves), higher HbA1c, and longer diabetes duration. In practice, this highlights the importance of adequate protein intake and incorporating resistance exercises as key components to reduce the risk of muscle mass loss during weight reduction [45,46]. In addition, the reduction in FFM was consistent with the overall decrease in body weight and abdominal circumference observed during the intervention. Nevertheless, because BIA-derived estimates of FFM depend largely on total body water, some influence of hydration status cannot be excluded, even under carefully standardised measurement conditions in line with ESPEN recommendations [19,47,48].\u003c/p\u003e\n\u003cp\u003eRegarding lipid parameters, a significant improvement was observed for triglycerides. Meta-analytic evidence indicates that weight reduction is one of the key factors associated with lowering triglyceride levels [49]. The absence of significant changes in total cholesterol and LDL-C may be related to concomitant use of lipid-lowering therapy, which could have limited the potential to detect additional intervention effects.\u003c/p\u003e\n\u003cp\u003eFinally, it is worth highlighting the group-based structure of the intervention. Participants took part in group education delivered by an MDT including a GP/diabetologist, a dietitian, a psychologist, and a nurse. Evidence comparing individual and group education in people with T2DM suggests that group-based approaches can yield favourable outcomes, including improvements in HbA1c, body weight, waist circumference, triglycerides, and diabetes related knowledge. Moreover, interventions delivered with a group component have more often been associated with greater HbA1c improvement than those implemented without peer-group support [50,51]. At the same time, available evidence indicates that effects may be stronger when CGM is combined with behavioural or educational interventions, resulting in greater improvements in glycaemic and psychosocial outcomes than CGM alone or education alone [52]. Similarly, combining diabetes self-management education and support (DSMES) with intermittently scanned CGM (isCGM) has been associated with a larger reduction in HbA1c compared with DSMES alone [53]. Taken together, these findings suggest that periodic use of CGM as an adjunct to group-based education may enhance the effectiveness of lifestyle-focused interventions.\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. The lack of randomisation and the small sample size limit the generalisability of the findings. In addition, outcomes were compared between participants using CGM and SMBG without a parallel control group receiving usual care, which makes it difficult to attribute the observed changes solely to the intervention. Another limitation is the 6-month follow-up, which does not allow assessment of the durability of the effects, while long-term maintenance of lifestyle changes is crucial for sustained success. Finally, body composition assessed by BIA, although standardised, remains sensitive to changes in hydration status, which may affect the accuracy of FFM estimates. Given the growing interest in lifestyle interventions in the care of people with type 2 diabetes, further studies with larger sample sizes are warranted.\u003c/p\u003e"},{"header":"5.\tConclusion ","content":"\u003cp\u003eThese findings suggest that a structured, group-based lifestyle programme delivered by an MDT can be implemented in routine care for people with type 2 diabetes in Poland and may lead to clinically meaningful improvements in glycaemic control and body weight. Greater reductions in weight and BMI among CGM users indicate that intermittent CGM, when integrated into structured education, may provide additional benefit.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCARE4DIABETES consortium (alphabetical order): Agapiou Mar\u0026iacute;a, Aittola Kirsikka, Anjos Madalena, \u003cstrong\u003eDziklińska Patrycja\u003c/strong\u003e, Balasopoulou Anastasia, Ballov\u0026aacute; Nat\u0026aacute;lia, Becherini Benedetta, Borg Buontempo Mariella, Brunec Anja, Bulzomi Rocco, Burgaz Celia, Busuttil Glorianne, Ceccarelli Anna, Csizmadia P\u0026eacute;ter, Diankova Snejanka, Do \u0026Oacute; Dulce, Do Vale Sonia, Dourou Ioanna, Drakopoulou Evaggelia, Escribano-Santamarina Mar\u0026iacute;a, Espino Isabel, Fatyga Emilia, Georgieva Silvia, Gonz\u0026aacute;lez Paloma, Gonzalvez-Mu\u0026ntilde;oz Ainhoa, Hasomeri Anastasia, Hristov Kristiyan, \u003cstrong\u003eJeznach-Steinhagen Anna\u003c/strong\u003e\u003cstrong\u003e, \u003cstrong\u003eKozłowski Rafał\u003c/strong\u003e,\u003c/strong\u003e Kirsikka Aittola, \u003cstrong\u003eKułaga Katarzyna\u003c/strong\u003e, Lasilla-Cruz Luc\u0026iacute;a, Llaneza-Su\u0026aacute;rez Elvira, Madalena Anjos, Mart\u0026iacute;nez-Brocca M\u0026ordf; Asunci\u0026oacute;n, Milivoj Piletic, Merayo-Galb\u0026aacute;n Antonio, Motta Laura, Ochoa-Gonz\u0026aacute;lez Raquel, Opresnik Denis, Ostrowska Joanna, Papadimitriou Konstantinos, Paraschou Eleni Maria, Parras Nuria, Peteh Claudia, Piaggesi Alberto, Pitocco Dario, Popovska Snezhana, Prieto-Santos Nuria, Psaltopoulou Theodora, Raposo Jo\u0026atilde;o Filipe, Ravnachka Bianka, Ribeiro Rog\u0026eacute;rio, Rodr\u0026iacute;guez-Acu\u0026ntilde;a Rafael, Saarelainen Eeva, \u003cstrong\u003eSekuła Marzena\u003c/strong\u003e, Sender\u0026aacute;kov\u0026aacute; Soňa, Silva S\u0026oacute;nia, \u003cstrong\u003eSosnowska Maja\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e Stavroula Paschou, Su\u0026aacute;rez Silvia, Tabone-Trapani Denise, Tamburi Tania, Tase Iliya, TheocharidisTheodoros, Tiia Eho, \u003cstrong\u003eToczyłowska Klaudia\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e Tom\u0026eacute;-P\u0026eacute;rez Yolanda, Tyufekchieva Mariya, Valtanen Mikko, Valve P\u0026auml;ivi, Vandevijvere Stefanie, Vassallo Paula, V\u0026aacute;zquez- Salvi Luis Alberto, Viegas Ana, Wikstr\u0026ouml;m Katja, Zacharaki Panagiota, Zoran Katančić, Zouroudi Emmanouela.\u003c/p\u003e\n\u003cp\u003eThis study was supported by the European Union and HADEA and co-financed by the Polish Ministry of Science and Higher Education under the program \u0026quot;International Co-financed Projects\u0026quot;.\u003c/p\u003e\n\u003cp\u003eWe would like to express our sincere appreciation to Martiatt Antoinette and Maria Vasile as Project Officers for the project implementation. We would also like to thank Roc\u0026iacute;o Allande, General Manager, for the institutional support she provides to the coordinating team from the General Directorate of Care and Socio-Health Coordination of the Ministry of Health of Asturias.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or HADEA. Neither the European Union nor the granting authority can be held responsible for them.\u003c/p\u003e\n\u003cp\u003eProject co-financed by the Polish Ministry of Science and Higher Education under the program \u0026quot;International Co-financed Projects\u0026quot;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJ.O. conceived the concept of this manuscript, coordinated the Polish cohort analysis, contributed to study implementation and data collection, interpreted the data and drafted the manuscript. E.K. and M.P. contributed to data collection, study implementation, drafting of the manuscript, particularly the Discussion section, and critical revision of the manuscript. A.S. and K.W. contributed to data collection, study implementation and critical revision of the manuscript. M.M.P.-G. contributed to the overall conceptual framework of the CARE4DIABETES project, interpretation of the findings and critical revision of the manuscript. All authors reviewed the manuscript, approved the final version and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets analysed during the current study are not publicly available due to privacy and ethical restrictions related to participant-level clinical data but are available from the corresponding author on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional Information\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Competing interests: The authors declare no competing interests\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eInternational Diabetes Federation. IDF Diabetes Atlas. 11th ed. International Diabetes Federation, Brussels Global Diabetes Data \u0026amp; Insights | IDF Diabetes Atlas. (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeBlanc, E. S. et al. Behavioral and pharmacotherapy weight loss interventions to prevent obesity-related morbidity and mortality in adults: updated evidence report and systematic review for the US Preventive Services Task Force. \u003cem\u003eJAMA\u003c/em\u003e \u003cb\u003e320\u003c/b\u003e, 1172\u0026ndash;1191. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jama.2018.7777\u003c/span\u003e\u003cspan address=\"10.1001/jama.2018.7777\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElSayed, N. A. et al. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes\u0026thinsp;\u0026ndash;\u0026thinsp;2023. \u003cem\u003eDiabetes Care\u003c/em\u003e. \u003cb\u003e46\u003c/b\u003e (Suppl 1), S10\u0026ndash;S18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2337/dc23-S001\u003c/span\u003e\u003cspan address=\"10.2337/dc23-S001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD). Evidence-based European recommendations for the dietary management of diabetes. \u003cem\u003eDiabetologia\u003c/em\u003e \u003cb\u003e66\u003c/b\u003e, 965\u0026ndash;985. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00125-023-05894-8\u003c/span\u003e\u003cspan address=\"10.1007/s00125-023-05894-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLingvay, I., Sumithran, P. \u0026amp; Cohen, R. V. le Roux, C. W. Obesity management as a primary treatment goal for type 2 diabetes: time to reframe the conversation. \u003cem\u003eLancet\u003c/em\u003e \u003cb\u003e399\u003c/b\u003e, 394\u0026ndash;405. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(21)01919-X\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(21)01919-X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAraszkiewicz, A. et al. Standards of Care in Diabetes. The position of Diabetes Poland \u0026ndash; 2025. \u003cem\u003eCurr. Top. Diabet.\u003c/em\u003e \u003cb\u003e5\u003c/b\u003e (1), 1\u0026ndash;158. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5114/ctd/203685\u003c/span\u003e\u003cspan address=\"10.5114/ctd/203685\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTu, Q. et al. The effects of multidisciplinary collaborative care on cardiovascular risk factors among patients with diabetes in primary care settings: A systematic review and meta-analysis. \u003cem\u003ePrim. Care Diabetes\u003c/em\u003e. \u003cb\u003e18\u003c/b\u003e, 381\u0026ndash;392. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.pcd.2024.05.003\u003c/span\u003e\u003cspan address=\"10.1016/j.pcd.2024.05.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMustapa, A., Justine, M. \u0026amp; Manaf, H. Effects of patient education on the quality of life of patients with type 2 diabetes mellitus: a scoping review. \u003cem\u003eMalays Fam Physician\u003c/em\u003e. \u003cb\u003e17\u003c/b\u003e (3), 22\u0026ndash;32. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.51866/rv.208\u003c/span\u003e\u003cspan address=\"10.51866/rv.208\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteinsbekk, A. et al. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus: a systematic review with meta-analysis. \u003cem\u003eBMC Health Serv. Res.\u003c/em\u003e \u003cb\u003e12\u003c/b\u003e, 213. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1472-6963-12-213\u003c/span\u003e\u003cspan address=\"10.1186/1472-6963-12-213\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2012).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Diabetes Association. Diabetes Technology: Standards of Care in Diabetes\u0026thinsp;\u0026ndash;\u0026thinsp;2025. \u003cem\u003eDiabetes Care\u003c/em\u003e. \u003cb\u003e48\u003c/b\u003e (Suppl 1), S146\u0026ndash;S159. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2337/dc25-S007\u003c/span\u003e\u003cspan address=\"10.2337/dc25-S007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoschonis, G. et al. Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials. \u003cem\u003eLancet Digit. Health\u003c/em\u003e. \u003cb\u003e5\u003c/b\u003e, e125\u0026ndash;e143. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S2589-7500(22)00233-3\u003c/span\u003e\u003cspan address=\"10.1016/S2589-7500(22)00233-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSherifali, D. et al. Effect of diabetes health coaching on glycemic control and quality of life in adults living with type 2 diabetes: a community-based, randomized, controlled trial. \u003cem\u003eCan. J. Diabetes\u003c/em\u003e. \u003cb\u003e45\u003c/b\u003e, 594\u0026ndash;600. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jcjd.2020.11.012\u003c/span\u003e\u003cspan address=\"10.1016/j.jcjd.2020.11.012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePot, G. K. et al. Nutrition and lifestyle intervention in type 2 diabetes: pilot study in the Netherlands showing improved glucose control and reduction in glucose lowering medication. \u003cem\u003eBMJ Nutr. Prev. Health\u003c/em\u003e. \u003cb\u003e2\u003c/b\u003e, 43\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjnph-2018-000012\u003c/span\u003e\u003cspan address=\"10.1136/bmjnph-2018-000012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilmsen, N., Pijl, H., Geerlings, W. \u0026amp; Navis, G. Retrospective analysis on the effect of Reverse Diabetes2 Now on kidney function in patients with type 2 diabetes with impaired kidney function. \u003cem\u003eBMJ Nutr. Prev. Health\u003c/em\u003e. \u003cb\u003e5\u003c/b\u003e, 271\u0026ndash;276. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjnph-2021-000397\u003c/span\u003e\u003cspan address=\"10.1136/bmjnph-2021-000397\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePot, G. K. et al. Observational study on dietary changes of participants following a multicomponent lifestyle program (Reverse Diabetes2 Now). \u003cem\u003eJ. Hum. Nutr. Diet.\u003c/em\u003e \u003cb\u003e35\u003c/b\u003e, 791\u0026ndash;803. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jhn.12976\u003c/span\u003e\u003cspan address=\"10.1111/jhn.12976\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePot, G. K. et al. Lifestyle medicine for type 2 diabetes: practice-based evidence for long-term efficacy of a multicomponent lifestyle intervention (Reverse Diabetes2 Now). \u003cem\u003eBMJ Nutr. Prev. Health\u003c/em\u003e. \u003cb\u003e3\u003c/b\u003e, 188\u0026ndash;195. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjnph-2020-000081\u003c/span\u003e\u003cspan address=\"10.1136/bmjnph-2020-000081\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiez-Valcarce, I. et al. Multidisciplinary lifestyle treatment for type 2 diabetes in 12 European countries: protocol for a quasi-experimental study. \u003cem\u003eBMC Public. Health\u003c/em\u003e. \u003cb\u003e25\u003c/b\u003e, 1069. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12889-025-22246-w\u003c/span\u003e\u003cspan address=\"10.1186/s12889-025-22246-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Vries, H. An integrated approach for understanding health behavior; the I-change model as an example. \u003cem\u003ePsychol. Behav. Sci. Int. J.\u003c/em\u003e \u003cb\u003e2\u003c/b\u003e (2), 555585. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.19080/pbsij.2.2\u003c/span\u003e\u003cspan address=\"10.19080/pbsij.2.2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLochs, H. et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, definitions and general topics. \u003cem\u003eClin. Nutr.\u003c/em\u003e \u003cb\u003e25\u003c/b\u003e, 180\u0026ndash;186. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.clnu.2006.02.007\u003c/span\u003e\u003cspan address=\"10.1016/j.clnu.2006.02.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2006).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSartore, G., Ragazzi, E., Caprino, R. \u0026amp; Lapolla, A. Long-term HbA1c variability and macro-/micro-vascular complications in type 2 diabetes mellitus: a meta-analysis update. \u003cem\u003eActa Diabetol.\u003c/em\u003e \u003cb\u003e60\u003c/b\u003e (6), 721\u0026ndash;738. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00592-023-02037-8\u003c/span\u003e\u003cspan address=\"10.1007/s00592-023-02037-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang, S. et al. Glycated haemoglobin variability and risk of renal function decline in type 2 diabetes mellitus: An updated systematic review and meta-analysis. \u003cem\u003eDiabetes Obes. Metab.\u003c/em\u003e \u003cb\u003e26\u003c/b\u003e (11), 5167\u0026ndash;5182. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/dom.15861\u003c/span\u003e\u003cspan address=\"10.1111/dom.15861\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChew, S. M., Avinashi, D., Venkataraman, K. \u0026amp; S., \u0026amp; Predictors of incident diabetic peripheral neuropathy: a systematic review of longitudinal studies in patients with diabetes mellitus. \u003cem\u003eRev. Endocr. Metab. Disord\u003c/em\u003e. \u003cb\u003e26\u003c/b\u003e (4), 659\u0026ndash;677. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11154-025-09973-6\u003c/span\u003e\u003cspan address=\"10.1007/s11154-025-09973-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLean, M. E. et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. \u003cem\u003eLancet (London England)\u003c/em\u003e. \u003cb\u003e391\u003c/b\u003e (10120), 541\u0026ndash;551. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(17)33102-1\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(17)33102-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHallberg, S. J. et al. Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: An open-label, non-randomized, controlled study. \u003cem\u003eDiabetes Ther.\u003c/em\u003e \u003cb\u003e9\u003c/b\u003e (2), 583\u0026ndash;612. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s13300-018-0386-4\u003c/span\u003e\u003cspan address=\"10.1007/s13300-018-0386-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHanick, C. J., Peterson, C. M., Davis, B. C., Sabat\u0026eacute;, J. \u0026amp; Kelly, J. H. Jr. A whole-food, plant-based intensive lifestyle intervention improves glycaemic control and reduces medications in individuals with type 2 diabetes: a randomised controlled trial. \u003cem\u003eDiabetologia\u003c/em\u003e \u003cb\u003e68\u003c/b\u003e (2), 308\u0026ndash;319. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00125-024-06272-8\u003c/span\u003e\u003cspan address=\"10.1007/s00125-024-06272-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFernandez-Alvarez, D. M., Pap\u0026iacute;n-Cano, M., Surendran, C., Martin-Payo, R. \u0026amp; S., \u0026amp; Td2Ast project: A pragmatic intervention on diet and physical activity for patients with type 2 diabetes mellitus. \u003cem\u003ePrim. Care Diabetes\u003c/em\u003e. \u003cb\u003e19\u003c/b\u003e (3), 270\u0026ndash;276. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.pcd.2025.02.003\u003c/span\u003e\u003cspan address=\"10.1016/j.pcd.2025.02.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin, C. L., Huang, L. C., Chang, Y. T., Chen, R. Y. \u0026amp; Yang, S. H. Effectiveness of health coaching in diabetes control and lifestyle improvement: A randomized-controlled trial. \u003cem\u003eNutrients\u003c/em\u003e \u003cb\u003e13\u003c/b\u003e (11), 3878. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/nu13113878\u003c/span\u003e\u003cspan address=\"10.3390/nu13113878\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSukkarieh-Haraty, O. et al. Results from the first culturally tailored, multidisciplinary diabetes education in Lebanese adults with type 2 diabetes: effects on self-care and metabolic outcomes. \u003cem\u003eBMC Res. Notes\u003c/em\u003e. \u003cb\u003e15\u003c/b\u003e (1), 39. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13104-022-05937-0\u003c/span\u003e\u003cspan address=\"10.1186/s13104-022-05937-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBannuru, R. R. et al. Continuous glucose monitoring to guide lifestyle choices with a focus on nutrition in the management of type 2 diabetes: A systematic review and meta-analysis. \u003cem\u003eJ. Diabetes Sci. Technol.\u003c/em\u003e \u003cb\u003e19322968251384318\u003c/b\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/19322968251384318\u003c/span\u003e\u003cspan address=\"10.1177/19322968251384318\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLind, N., Christensen, M. B., Hansen, D. L. \u0026amp; N\u0026oslash;rgaard, K. Comparing continuous glucose monitoring and blood glucose monitoring in adults with inadequately controlled, insulin-treated type 2 diabetes (Steno2tech Study): A 12-month, single-center, randomized controlled trial. \u003cem\u003eDiabetes Care\u003c/em\u003e. \u003cb\u003e47\u003c/b\u003e (5), 881\u0026ndash;889. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2337/dc23-2194\u003c/span\u003e\u003cspan address=\"10.2337/dc23-2194\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerreira, R. O. M. et al. Continuous glucose monitoring systems in noninsulin-treated people with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. \u003cem\u003eDiabetes Technol. Ther.\u003c/em\u003e \u003cb\u003e26\u003c/b\u003e (4), 252\u0026ndash;262 (2024). 0.1089/dia.2023.0390.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUhl, S., Choure, A., Rouse, B., Loblack, A. \u0026amp; Reaven, P. Effectiveness of continuous glucose monitoring on metrics of glycemic control in type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials. \u003cem\u003eJ. Clin. Endocrinol. Metab.\u003c/em\u003e \u003cb\u003e109\u003c/b\u003e (4), 1119\u0026ndash;1131. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1210/clinem/dgad652\u003c/span\u003e\u003cspan address=\"10.1210/clinem/dgad652\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuijzer, G. et al. Effect and maintenance of the SLIMMER diabetes prevention lifestyle intervention in Dutch primary healthcare: a randomised controlled trial. \u003cem\u003eNutr. Diabetes\u003c/em\u003e. \u003cb\u003e7\u003c/b\u003e (5), e268. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/nutd.2017.21\u003c/span\u003e\u003cspan address=\"10.1038/nutd.2017.21\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFranz, M. J., Boucher, J. L., Rutten-Ramos, S. \u0026amp; VanWormer, J. J. Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. \u003cem\u003eJ. Acad. Nutr. Diet.\u003c/em\u003e \u003cb\u003e115\u003c/b\u003e (9), 1447\u0026ndash;1463. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jand.2015.02.031\u003c/span\u003e\u003cspan address=\"10.1016/j.jand.2015.02.031\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePalmer, R. et al. Associations between decreases in adiposity and reductions in HbA1c and insulin use in the look AHEAD cohort. \u003cem\u003eObes. (Silver Spring Md)\u003c/em\u003e. \u003cb\u003e33\u003c/b\u003e (3), 612\u0026ndash;620. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/oby.24242\u003c/span\u003e\u003cspan address=\"10.1002/oby.24242\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShinde, S. et al. Impact of weight change on glycemic control and metabolic parameters in T2D: A retrospective US study based on real-world data. \u003cem\u003eDiabetes\u003c/em\u003e \u003cb\u003e15\u003c/b\u003e (2), 409\u0026ndash;426. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s13300-023-01511-4\u003c/span\u003e\u003cspan address=\"10.1007/s13300-023-01511-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeng, L., Jia, L., Wu, X. L. \u0026amp; Cheng, M. Association between body mass index and glycemic control in type 2 diabetes mellitus: A cross-sectional study. \u003cem\u003eDiabetes Metab. Syndr. Obes.\u003c/em\u003e \u003cb\u003e18\u003c/b\u003e, 555\u0026ndash;563. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/DMSO.S508365\u003c/span\u003e\u003cspan address=\"10.2147/DMSO.S508365\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWillis, H. J., Johnson, E. \u0026amp; JaKa, M. A nutrition-focused approach during continuous glucose monitoring initiation in people with type 2 diabetes: using a theoretical framework to unite continuous glucose monitoring and food choices. \u003cem\u003eJ. Diabetes Sci. Technol.\u003c/em\u003e \u003cb\u003e19\u003c/b\u003e (5), 1400\u0026ndash;1406. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/19322968241247559\u003c/span\u003e\u003cspan address=\"10.1177/19322968241247559\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRosenfeld, R. M., Grega, M. L. \u0026amp; Gulati, M. Lifestyle interventions for treatment and remission of type 2 diabetes and prediabetes in adults: implications for clinicians. \u003cem\u003eAm. J. Lifestyle Med.\u003c/em\u003e \u003cb\u003e15598276251325802\u003c/b\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/15598276251325802\u003c/span\u003e\u003cspan address=\"10.1177/15598276251325802\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e[48] Peng, M., Shen, P. \u0026amp; Kim, K. J. Effects of continuous glucose monitoring on physical activity and diet in diabetes: a systematic review and meta-analysis. \u003cem\u003eInt. J. Behav. Nutr. Phys. Act.\u003c/em\u003e \u003cb\u003e23\u003c/b\u003e (1), 14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12966-025-01870-0\u003c/span\u003e\u003cspan address=\"10.1186/s12966-025-01870-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2026).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichardson, K. M. et al. The efficacy of using continuous glucose monitoring as a behaviour change tool in populations with and without diabetes: a systematic review and meta-analysis of randomised controlled trials. \u003cem\u003eInt. J. Behav. Nutr. Phys. Act.\u003c/em\u003e \u003cb\u003e21\u003c/b\u003e (1), 145. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12966-024-01692-6\u003c/span\u003e\u003cspan address=\"10.1186/s12966-024-01692-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGriauzde, D. H. et al. Continuous glucose monitoring with low-carbohydrate nutritional coaching to improve type 2 diabetes control: randomized quality improvement program. \u003cem\u003eJ. Med. Internet Re\u003c/em\u003e. \u003cb\u003e24\u003c/b\u003e (2), e31184. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2196/31184\u003c/span\u003e\u003cspan address=\"10.2196/31184\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLowrie, F. J. et al. The impact of exercise on fat free mass reduction during very low energy diet-induced weight loss in adults with overweight or obesity: A systematic review and meta-analysis. \u003cem\u003eObes. Res. Clin. Pract.\u003c/em\u003e \u003cb\u003e19\u003c/b\u003e (5), 380\u0026ndash;387. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.orcp.2025.10.001\u003c/span\u003e\u003cspan address=\"10.1016/j.orcp.2025.10.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeng, L. et al. Prevalence and risk factors of sarcopenia in patients with diabetes: A meta-analysis. \u003cem\u003eJ. Clin. Endocrinol. Metab.\u003c/em\u003e \u003cb\u003e107\u003c/b\u003e (5), 1470\u0026ndash;1483. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1210/clinem/dgab884\u003c/span\u003e\u003cspan address=\"10.1210/clinem/dgab884\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang, M. et al. Diabetes and sarcopenic obesity: pathogenesis, diagnosis, and treatments. \u003cem\u003eFront. Endocrinol. (Lausanne)\u003c/em\u003e. \u003cb\u003e11\u003c/b\u003e, 568. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fendo.2020.00568\u003c/span\u003e\u003cspan address=\"10.3389/fendo.2020.00568\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIzzo, A., Massimino, E., Riccardi, G. \u0026amp; Della Pepa, G. A narrative review on sarcopenia in type 2 diabetes mellitus: prevalence and associated factors. \u003cem\u003eNutrients\u003c/em\u003e \u003cb\u003e13\u003c/b\u003e (1), 183. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/nu13010183\u003c/span\u003e\u003cspan address=\"10.3390/nu13010183\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKyle, U. G. et al. Bioelectrical impedance analysis - part I: review of principles and methods. \u003cem\u003eClin. Nutr.\u003c/em\u003e \u003cb\u003e23\u003c/b\u003e, 1226\u0026ndash;1243. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.clnu.2004.06.004\u003c/span\u003e\u003cspan address=\"10.1016/j.clnu.2004.06.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2004).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeurenberg, P. et al. Changes in fat-free mass during weight loss measured by bioelectrical impedance and by densitometry. \u003cem\u003eAm. J. Clin. Nutr.\u003c/em\u003e \u003cb\u003e49\u003c/b\u003e, 33\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/ajcn/49.1.33\u003c/span\u003e\u003cspan address=\"10.1093/ajcn/49.1.33\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (1989).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHasan, B. et al. Weight loss and serum lipids in overweight and obese adults: A systematic review and meta-analysis. \u003cem\u003eJ. Clin. Endocrinol. Metab.\u003c/em\u003e \u003cb\u003e105\u003c/b\u003e (12). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1210/clinem/dgaa673\u003c/span\u003e\u003cspan address=\"10.1210/clinem/dgaa673\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMannucci, E. et al. Self-management in patients with type 2 diabetes: Group-based versus individual education. A systematic review with meta-analysis of randomized trails. \u003cem\u003eNutrit Netab Cardiovasc. Dis. NMCD\u003c/em\u003e. \u003cb\u003e32\u003c/b\u003e (2), 330\u0026ndash;336. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.numecd.2021.10.005\u003c/span\u003e\u003cspan address=\"10.1016/j.numecd.2021.10.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOdgers-Jewell, K. et al. Effectiveness of group-based self-management education for individuals with type 2 diabetes: a systematic review with meta-analyses and meta-regression. \u003cem\u003eDiabet. Med.\u003c/em\u003e \u003cb\u003e34\u003c/b\u003e (8), 1027\u0026ndash;1039. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/dme.13340\u003c/span\u003e\u003cspan address=\"10.1111/dme.13340\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark, Y. et al. Impact of real-time continuous glucose monitoring and personalized digital health coaching on glycemic control and lifestyle in patients with type 2 diabetes and prediabetes. \u003cem\u003ePrim. Care Diabetes\u003c/em\u003e. \u003cb\u003e20\u003c/b\u003e (1), 61\u0026ndash;67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.pcd.2025.12.002\u003c/span\u003e\u003cspan address=\"10.1016/j.pcd.2025.12.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2026).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAronson, R. et al. Impact of flash glucose monitoring in people with type 2 diabetes inadequately controlled with non-insulin antihyperglycaemic therapy (IMMEDIATE): A randomized controlled trial. \u003cem\u003eDiabetes Obes. Metab.\u003c/em\u003e \u003cb\u003e25\u003c/b\u003e (4), 1024\u0026ndash;1031. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/dom.14949\u003c/span\u003e\u003cspan address=\"10.1111/dom.14949\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"type 2 diabetes, lifestyle, self-monitoring of blood glucose (SMBG), continuous glucose monitoring (CGM), HbA1c, weight loss","lastPublishedDoi":"10.21203/rs.3.rs-9169658/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9169658/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eType 2 diabetes remains a major public health challenge, requiring lifelong management. Structured lifestyle-based interventions are increasingly recognised for their role in supporting self-management. The CARE4DIABETES (C4D) programme, part of a Joint Action funded by the EU4Health initiative, aims to implement and evaluate a behavioural lifestyle model (Reverse Diabetes2 Now) across 12 European countries.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eC4D is a 12-month, quasi-experimental, structured, digitally supported lifestyle programme comprising multiple group-based educational sessions delivered by a multidisciplinary team (MDT) and addressing nutrition, physical activity, sleep, and stress management. This interim analysis includes the Polish cohort (n\u0026thinsp;=\u0026thinsp;38; type 2 diabetes duration\u0026thinsp;\u0026le;\u0026thinsp;10 years), presented overall and stratified by continuous glucose monitoring (CGM) users (n\u0026thinsp;=\u0026thinsp;21) versus self-monitoring of blood glucose (SMBG, n\u0026thinsp;=\u0026thinsp;17).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAt 6 months, participants showed significant improvements. Mean HbA1c decreased by 0.78 percentage points (\u0026ndash;10.9%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) to 6.35%. Body weight decreased by 6.04 kg (\u0026ndash;6.5%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), waist circumference by 6.77 cm (\u0026ndash;6.4%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), fat mass by 2.47 kg (\u0026ndash;7.2%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and triglycerides by 20.3% (p\u0026thinsp;=\u0026thinsp;0.023), while total cholesterol, LDL-C, and HDL-C did not change significantly. Improvements were numerically larger in the CGM group. Between-group comparisons of change scores showed greater reductions in body weight and BMI in the CGM group compared with the SMBG group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Cohen\u0026rsquo;s d\u0026thinsp;\u0026asymp;\u0026thinsp;0.9\u0026ndash;1.0).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe 6-month intensive phase of this structured, group-based lifestyle education programme was associated with clinically meaningful improvements in glycaemic control and anthropometric outcomes. Improvements were greater among CGM users than in the SMBG group, suggesting that integrating CGM into structured education may further enhance programme outcomes.\u003c/p\u003e","manuscriptTitle":"Lifestyle intervention outcomes in T2DM and the added value of CGM: 6-month results from the Polish cohort of the C4D study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-21 10:14:03","doi":"10.21203/rs.3.rs-9169658/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-28T06:43:56+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-27T01:41:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-23T05:12:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-19T14:41:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"140955893476504639961253209974234704143","date":"2026-04-15T12:08:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"159262531186047581901982189202641699628","date":"2026-04-14T16:34:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"316855336188374799798308966086426492127","date":"2026-04-13T19:25:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-13T06:23:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-13T05:19:29+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-25T10:42:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-24T09:24:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-03-24T09:17:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fce199ac-130c-4744-9d60-eae72f2f702e","owner":[],"postedDate":"April 21st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":66600090,"name":"Health sciences/Diseases"},{"id":66600091,"name":"Health sciences/Endocrinology"},{"id":66600092,"name":"Health sciences/Health care"},{"id":66600093,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-05-06T05:24:46+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-21 10:14:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9169658","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9169658","identity":"rs-9169658","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}