Background Type 2 diabetes mellitus (T2D), is a life-threatening condition of global public health concern. It worsens in the presence of the metabolic syndrome (MetS), a complex disorder characterized by co-occurrence of at least three of such factors as hypertension, obesity, dyslipidemia and insulin resistance. However, lifestyle interventions reduce the risk of both MetS and T2D, and nutrition education can empower individuals on the appropriate, lifestyle changes. The aim of the current study was to evaluate the effect of a nutrition education programme, with and without inclusion of peer to peer support, on MetS in T2D patients. Methods This was a randomized controlled trial with two intervention groups and one control. One of the intervention groups involved a nutrition education programme with peer-to-peer support (NEP); the other involved only the education program, while the control received standard care. Each group had 51 participants. The nutrition education programme was conducted for 2 h per week for 8 weeks. In addition, the NEP had weekly peer-to-peer interactions for 8 weeks. All groups had follow-up sessions for 6 months. Data on MetS risk factors as well as food intake patterns and physical activity levels were taken at baseline and at different time points during the study. Analysis of Co-variance and regression were used in the analysis. Results The MetS prevalence improved in the NEP (90 to 52%) and NE (86 to 69%), while it worsened in C (88 to 91%). There was improvement in the mean values of the anthropometric parameters in the NEP and NE which worsened in the control group. There was a general improvement in mean values of blood lipids, fasting blood glucose and HbA1c in all the groups, with NEP showing the greatest improvements, followed by NE, except for triglycerides and HDL where the control group had better improvement than the NE. Changes in the anthropometric and metabolic indicators mirrored the changes in food intake patterns and physical activity, where the greatest improvements occurred in the NEP. Conclusions Nutrition education with inclusion of peer to peer support was of clinical benefit in improving metabolic outcomes and reducing MetS in T2DM patients. Trial registration The study has been registered retrospectively by Pan African Clinical Trial Registry; Registration No: PACTR201910518676391 .

Type 2 Diabetes Mellitus is a metabolic disorder characterized by hyperglycemia due to relative insulin secretion deficiency and insulin resistance. It is a global public health concern with increasing prevalence each year. Social demographic, lifestyle and metabolic characteristic, play a crucial role in development and progression of Type 2 diabetes mellitus. Poor glycemic control worsens the condition, leading to complications that are very costly to treat. This calls for a need to explore the relationship between patient characteristics and glycemic control (HbA1c). One hundred and fifty three (153) participants with Type 2 diabetes mellitus aged 20-79 years and attending the Thika Level Five Hospital were enrolled in the study. Sociodemographic, clinical and lifestyle data were obtained using questionnaires. The nutrition status was determined by anthropometry. Lipid profile that included total cholesterol, (TC); high density lipoprotein-cholesterol, (HDL-c); low density lipoprotein cholesterol, (LDL-c) and triglyceride, (TG,) were determined by enzymatic method while glycated hemoglobin (HbA1c) and fasting blood sugar (FBS) were determined using high-performance liquid chromatography (HPLC) and glucose oxidase methods, respectively. Blood pressure of the patients was also determined. Overall sample size was 153 (40.5% men and 59.5% women). The overall mean age of patients was 56.07 years, and the mean age of patients with poor glycemic control (HbA1c>7%) was 56.79 years. The prevalence of the poor glycemic control (HbA1c>7%) was 77.8%. Participants with HbA1c > 7% showed statistically significant higher means for FBG, TC, and LDL-c than their counterparts with good glycemic control [11.71±3.11mmol/l vs. 8.54±3.19; 5.11±1.21mmol/l vs. 4.48±1.16 and 2.66±1.07 mmol/l vs. 2.22±1.04, respectively, (P<0.005; 0.000, 0.008 and 0.034, respectively]. The study showed a significant strong positive correlation between HbA1c and FBG (r=0.679, p<0.01); family history of diabetes, (FHD) (r=0.165, p<0.05); systolic blood pressure, (SBP) moderated with FHD (r=0.168, p<0.05); and diastolic blood pressure (DBP) moderated with FHD(r=0.181, p<0.05). In conclusion, poor glycemic control is associated with high/ blood pressure, high blood glucose and dyslipidemia, which are risk factors for macrovascular, microvascular and cardiovascular complications.