Mediterranean Diet Might Delay Need
for Drugs in Diabetes
Marlene Busko | 10th September 2009
By following a low-carbohydrate, Mediterranean diet rather than a low-fat diet, newly diagnosed diabetic patients may postpone the need for drugs to control this disease, a study suggests . After four years, with continued nutritional advice, only 44% of newly diagnosed diabetic patients on a Mediterranean diet vs 70% of those on a low-fat diet required drug therapy as well as diet to control their diabetes. Patients on the Mediterranean also showed greater improvement in some cardiovascular risk factors. “Perhaps most important, the findings reinforce the message that benefits of lifestyle interventions should not be overlooked, despite the drug-intensive style of medicine fueled by the current medical literature,” the authors write. The study, by Dr Katherine Esposito (Second University of Naples, Naples, Italy) and colleagues, is published in the September 1, 2009 issue of the Annals of Internal Medicine. “The study confirms that lifestyle changes are a basic part of managing diabetes,” Dr Christine Laine, editor of the Annals of Internal Medicine, told heartwire , adding that it also “suggests that people might be better off if the dietary advice they receive is in line with the Mediterranean diet.” Intense Nutritionist Support While a Mediterranean diet improves risk factors for cardiac disease and diabetes and the American Diabetes Association (ADA) recommends a low-carbohydrate or a low-fat diet for overweight people with type 2 diabetes, few studies have directly compared these diets in diabetes. To investigate the effectiveness of the two diets in delaying antihyperglycemic therapy, the researchers randomized 215 overweight patients (53% men) seen in a Naples hospital who were newly diagnosed with type 2 diabetes. The patients were sedentary, had a mean age of 52 years (range 30 to 75 years), a body-mass index greater than 25 kg/m2 (mean 29.6 kg/m2), and a hemoglobin A1c level of less than 11%. Most (77%) had an HbA1c level greater than 7%. The primary study outcome was time to introduction of antihyperglycemic therapy–predetermined to start when HbA1c levels were more than 7% at two measurements three months apart. Secondary outcomes included weight change, glycemic control, and attaining ADA coronary-risk-factor goals (HbA1c <7%; blood pressure <130/80 mm Hg; and low-density lipoprotein [LDL] cholesterol <2.59 mmol/L). Participants first received advice about the importance of diet and exercise and–of note–were taught how to prepare meals at home. They were then randomly assigned to one of two diets for four years:
- A Mediterranean diet, which included lots of vegetables and whole grains, with little red meat but with poultry and fish instead, where <50% of calories were from complex carbohydrates and >30% of calories were from fat, largely olive oil.
- A low-fat diet based on American Heart Association guidelines, which included lots of whole grains and restricted sweets, fats, and high-fat snacks, where <30% of calories were from fat.