From screening to lifestyle intervention: real-world results of HALT2Diabetes in high-risk adults

Background

Cardiometabolic diseases (CMD) are major public health challenges driven by modifiable lifestyle factors. Early identification and intervention for high-risk individuals (HRI) is essential. HALT2Diabetes is a Flemish prevention program using a stepwise approach: Web-based risk assessment (FINDRISC) followed by general practitioner (GP) consultation and referral to group-based lifestyle education. This study, situated within JACARDI, evaluates its real-world effectiveness and implementation outcomes.

Methods

A longitudinal repeated-measures study was conducted in 9 primary care regions across Flanders. HRI participated in 6 group-based lifestyle sessions led by dietitians. Data were collected at 5 time points over 12 months. Outcomes included behavioral, anthropometric, and biochemical measures. Linear mixed models assessed changes over time, including all available observations from the first 3 time points.

Results

Across Flanders, 3,756 individuals completed web-based risk assessment, identifying 1,490 HRI; 344 HRI participated in group-based lifestyle sessions. In 9 primary care regions implementing the study protocol, 87 participants were enrolled at baseline; 71 completed the intervention (82% retention). Significant improvements were observed, including an increase in dietary score (+4.6 points; p < 0.001), reductions in body weight (−1.5 kg; p < 0.001), waist circumference (−1.4 cm; p = 0.001), systolic blood pressure (−7.2 mmHg; p < 0.001), total cholesterol (−6.2 mg/dL; p = 0.047), and LDL cholesterol (−6.4 mg/dL; p = 0.002). Physical activity, diastolic blood pressure, HDL cholesterol, and HbA1c showed no significant change.

Conclusions

HALT2Diabetes improves cardiometabolic risk factors in a real-world setting for participants, but the intervention’s reach is low. Improving referral & retention could increase population level impact. Scaling across EU Member States may strengthen evidence and reduce burden of CMD, in line with the EU Safe Hearts Plan.

Key messages

• Group-based lifestyle education shows the potential to reduce cardiometabolic risk in high-risk populations but reach of current design is low.

• Optimising reach is necessary to increase population health impact. Scaling this model can strengthen EU prevention systems and reduce the burden of CVD and T2D.