d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 213 (2024) 111754 Available online 19 June 2024 0168-8227/© 2024 Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies. Effect of structured diet with exercise education on anthropometry and lifestyle modification in patients with type 2 diabetes: A 12-month randomized clinical trial Marwan El-Deyarbi a, b , Luai A. Ahmed c , Jeffrey King d, e , Huda Al Nuaimi f , Ahmed Al Juboori g , Nirmin A. Mansour g , Anan S. Jarab h, j , Derar H. Abdel-Qader i , Salahdein Aburuz a, * a Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates b Department of Pharmacy, Oud Al-Touba Diagnostic and Screening Clinic, Ambulatory Health Services, Abu Dhabi Health Services Co. (SEHA), Al Ain, United Arab Emirates c Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates d David Geffen School of Medicine at the University of California, Los Angeles, CA USA e Department of Veterans Affairs, Greater Los Angeles, Department of Geriatrics and Extended Care, Los Angeles, CA USA f Clinical Nutrition and Dietary Department, Oud Al-Touba Diagnostic and Screening Clinic, Ambulatory Health Services, Abu Dhabi Health Services Co. (SEHA), Al Ain, United Arab Emirates g Division of Endocrinology, Oud Al-Touba Diagnostic and Screening Clinic, Ambulatory Health Services, Abu Dhabi Health Services Co. (SEHA), Al Ain, United Arab Emirates h College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates i Faculty of Pharmacy & Medical Sciences, University of Petra, Amman, Jordan j Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan A R T I C L E INFO Keywords: SDSCA CR10 Metabolic Energy Carbohydrate UAE ABSTRACT Aims: Lifestyle modification involving active engagement of specialised dietitian with diet and exercise educa- tion, can be effective as first-line treatment for diabetes. Methods: 192 patients were enrolled with diabetes in a randomised controlled trial and followed up for one year. Ninety-four patients in the intervention group participated in a comprehensive structured diet and exercise education conducted by a specialised dietitian at ambulatory centre in the United Arab Emirates. Results: The mean difference in the change in body mass index between study groups at study exit and baseline was statistically significant (BMI difference = -1.86, 95 % CI  2.68 –  1.04, P < 0.01). The intervention group reported significant decrease in total carbohydrate and daily energy intake compared to baseline (173.7 g vs 221.1 g and 1828.5 kcal vs 2177.9 kcal, respectively). Moreover, the mean metabolic equivalents (METs) in the intervention group increased significantly at study exit from baseline compared to control group METs, with mean difference between all between-group differences after baseline of 0.63 (95 % 0.29 – 0.97, P < 0.01). Conclusions: Structured diet and exercise counselling by specialised dietitian in ambulatory settings significantly reduced carbohydrate and daily energy intake, with improved anthropometric measurements and physical activity. 1. Introduction Over the past 40 years, type 2 diabetes has become the more common and chronic disease worldwide; with a projected estimation of more than 600 million individual globally by 2045 [1,2]. Optimal glycaemic control with healthy body weight is the cornerstone of diabetes man- agement and prevention of micro- and macrovascular complications [3,4]. Nevertheless, lifestyle modification with increased exercise and dietary restriction with low-carbohydrate intake is the first early approach in disease management [5,6], and has favourable outcomes in terms of glycaemic control and weight loss [6]. Recent dietary carbohydrate guidelines in diabetes management advocate energy restriction with low carbohydrate, low fat, and high fibre content diets [7], leading to the development of carbohydrate- * Corresponding author. E-mail address: saburuz@uaeu.ac.ae (S. Aburuz). Contents lists available at ScienceDirect Diabetes Research and Clinical Practice journal homepage: www.journals.elsevier.com/diabetes-research-and-clinical-practice https://doi.org/10.1016/j.diabres.2024.111754 Received 19 February 2024; Received in revised form 12 June 2024; Accepted 17 June 2024