Feasibility and metabolic outcomes of a digital lifestyle intervention for type 2 diabetes in South African managed healthcare

Background: Type 2 diabetes (T2D) places a substantial burden on healthcare systems. Evidence for digital lifestyle interventions in South African managed healthcare is limited. Aim: To evaluate the feasibility and metabolic outcomes of a digital, dietitian-supported lifestyle intervention for adults with T2D in South African managed healthcare. Setting: A medical scheme diabetes management programme and a private general practice in South Africa. Methods: This 26-week, single-arm pretest–posttest pilot combined therapeutic carbohydrate restriction, structured education, personalised dietitian support and behavioural coaching alongside routine clinical care. Clinical, anthropometric and psychosocial outcomes were assessed at baseline and 6 months. Glycated haemoglobin (HbA1c) was the primary outcome. Results: Of 75 participants enrolled, 51 (68%) completed the intervention and 49 (65%) had paired HbA1c data. Mean HbA1c decreased by 0.8 percentage points (7.8% to 7.0%; p < 0.001). HbA1c improved in 42 of 49 participants (86%); 29 of 49 (59%) had reductions of at least 0.5 percentage points. Body mass, waist circumference, blood pressure, diabetes empowerment and perceived quality of care also improved significantly. Conclusion: The intervention was feasible and associated with improvements in glycaemic control, cardiometabolic risk factors and patient-reported outcomes. The findings support further evaluation of this approach within routine managed healthcare. Contribution: This study provides real-world implementation evidence for digital, dietitian-supported therapeutic carbohydrate restriction in South African managed healthcare.