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Mediterranean diet, more than low-fat, postponed diabetes medications
Following a Mediterranean eating regimen low in carbohydrates could help patients recently diagnosed with type 2 diabetes improve their HbA1c levels, delay their need for medication or achieve remission, according to research published in Diabetes Care.
Katherine Esposito, MD, of the University Hospital at the Second University of Naples, Italy, and colleagues followed up a trial that randomized men and women who were overweight, middle-aged and newly-diagnosed with diabetes to a low-carbohydrate Mediterranean diet (LCMD) (n=108) or low-fat diet (n=107).
The LCMD was rich in vegetables and whole grains, with more poultry and fish than red meat, and no more than 50% of calories from carbohydrates and no less than 30% calories from fat. The low-fat diet was rich in whole grains, restricted additional fats, sweets and high-fat snacks, with no more than 30% of calories from fat and no more than 10% of calories from saturated fat.
The participants, who had not begun treatment with diabetes medications at 4 years, were monitored until they either needed a drug or experienced partial or complete remission — defined as a transition to prediabetes or normal glucose levels, respectively. The researchers also evaluated weight changes, glycemic control and cardiovascular risk factors.
All participants in the low-fat group reached the primary end point of requiring medication by 6.1 years, and all in the LCMD group by 8.1 years; the average survival time was, respectively, 2.8 years (95% CI, 2.4-3.2) and 4.8 years (95% CI, 4.3-5.2). The overall follow-up hazard ratio, without adjustments, was 0.68 (0.50-0.89; P<.001).
The likelihood of experiencing any remission was greater with a LCMD compared with a low-fat diet; the prevalence was 14.7% (13.0–16.5%) during year 1 and 5.0% (4.4–5.6%) during year 6 vs. 4.1% (3.1–5.0%) during year 1 and 0% during year 6, respectively. Additionally, those on the LCMD diet were more likely to experienced sustained remission with 9.7% having a 3-year remission and 5.7% having a 4-year remission, as compared to 2% and 0%, respectively, in the low-fat group (P<.001 for 3 year data).
At 1 year of follow-up, greater improvements in HbA1c levels were seen with LCMD than low-fat (main effect: –0.5; 95% CI, –0.6 to –0.4%) and in all other measured cardiovascular risk factors.
“The results show that, compared with a traditional low-fat diet, an LCMD postpones the introduction of diabetes medications by approximately 2 years,” the researchers wrote, “and this effect was largely independent of weight loss.”
Disclosure: This study was supported by the Second University of Naples and the Associazione Salute con Stile.