Feasibility and Effects of a Produce Prescription Program (PRx) in People With Type 2 Diabetes and Low Socioeconomic Status: A Randomised Controlled Pilot Trial.

Abstract

Aims: Financial constraints often limit healthy eating among individuals with Type 2 diabetes (T2D) and lower socioeconomic status (SES). Produce Prescription Programs (PRx), which provide financial support for healthy foods, have shown promise in the United States but remain understudied in Europe. This study assessed the feasibility of a 3-month PRx intervention among adults with T2D and low SES, and explored its potential effects on dietary intake, metabolic outcomes and quality of life.

Materials and methods: In this 3-month RCT, conducted in primary care in Rotterdam, the Netherlands, adults with T2D, BMI > 25 kg/m² and low SES were assigned to either PRx or usual care. Both groups received three dietitian consultations and were advised to follow a Mediterranean diet. PRx additionally provided weekly plant-based food boxes, cooking workshops and educational support. Feasibility outcomes included recruitment, retention, adherence and acceptability. Exploratory efficacy outcomes included nutritional intake, anthropometric measures, metabolic outcomes and quality of life at three and 6 months.

Results: Seventy-seven individuals were screened and 35 participants (57.3 ± 11.8 years; 74% female; BMI 32.6 ± 6.0 kg/m²) were included, of whom 17 were allocated to PRx. Participants collected an average of 10.9 out of 12 food boxes (91%) and attended 1.8 out of 3 workshops (59%). Among the 11 participants (69%) who completed the evaluation questionnaire, satisfaction scores ranged from 4.3 to 4.7 out of 5. Exploratory between-group comparisons favoured the PRx group for dietary intake, weight, BMI and physical quality of life, while no clear differences were observed for glycaemic outcomes. These findings were supported by favourable within-group changes in dietary and anthropometric outcomes in the PRx group, several of which appeared to be maintained at 6-month follow-up.

Conclusions: This pilot RCT demonstrates that a 3-month PRx intervention providing plant-based food boxes is feasible and acceptable among adults with T2D and low SES. As the first European RCT evaluating a PRx intervention in this population, it provides preliminary evidence of potential benefits for dietary, anthropometric and quality of life outcomes, warranting further investigation in adequately powered trials.

Trial registration: OMON: NL-OMON57037; 8 October 2024.