Mediterranean Diet Improves Diabetes Control
Newly Diagnosed Diabetics May Delay the Use of Medications
Nov 5, 2009
By adhering to a Mediterranean diet and other lifestyle modifications, newly diagnosed diabetics might be able to delay taking medications for several years.
In keeping with current American Diabetes Association (ADA) guidelines, newly diagnosed diabetics are typically started on a treatment program that includes metformin – a drug that increases insulin sensitivity and lowers blood glucose– and lifestyle modifications designed to promote weight loss.
In order to induce the weight loss that is necessary for most type 2 diabetics, ADA dietary recommendations call for either a low-carbohydrate or low-fat, calorie-restricted diet.
A new study published in the Annals of Internal Medicine reveals that a Mediterranean diet is superior to the ADA-sanctioned approach for managing several diabetes-related parameters, even when both approaches confer similar degrees of weight loss. (Esposito K, Maiorino MI, Ciotola M, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Intern Med. 2009;151:306-314)
Diabetic Control Can Be Thwarted by Many Factors
Obesity is the primary contributor to the increasing incidence of diabetes in industrialized nations, and weight loss is the best documented intervention for controlling blood glucose levels in patients who have type 2 diabetes. (Link N. Dietary management of type 2 diabetes mellitus. West J Med. 1999;171:25-6)
Sedentary lifestyles and poor dietary choices are the underlying causes of obesity. Unfortunately, one of the most common reasons for poor diabetic control is lack of compliance with the necessary lifestyle changes that lead to weight loss.
Additionally, though, many medications that are designed to lower blood glucose in diabetics actually contribute to weight gain, which further frustrates patients and their physicians. Over time, even medications that do not cause weight gain often fail to adequately control blood sugars.
Therefore, once antihyperglycemic medications are instituted, patients often start chasing ever-increasing blood sugars and body weights and eventually transition to therapies that include insulin and a plethora of other drugs. Anything that would delay the need for antihyperglycemic drugs, then, would be of great benefit to newly diagnosed diabetics.
A Mediterranean Diet Confers Better Diabetic Control than Standard Low-Calorie Diets
In the Annals study, 215 subjects with newly diagnosed type 2 diabetes were randomized to receive either a Mediterranean diet or a low-fat diet based on American Heart Association guidelines.
The Mediterranean diet offered lots of vegetables and whole grains, but kept total calories from complex carbohydrates below 50%; it was low in red meat, and no less than 30% of its calories came from fat – mainly olive oil.
The AHA/ADA diet was also rich in whole grains but restricted its fat calories to less than 30% (with no more than 10% of total calories coming from saturated fat).
Both diets maintained energy intake at 1800 calories per day for men and 1500 calories for women, and each group received equal education on increasing exercise levels.
The study subjects were followed for up to four years to document when they required medications to keep their glycohemoglobin (HbA1c) levels below 7%. Other parameters that were recorded included weight changes, lipid levels, blood pressure, and degree of blood sugar control.
Important outcomes of the trial included:
- Although the group on the Mediterranean diet lost more weight during the first year, both groups showed a similar degree of weight loss by the end of the trial.
- Other measures of blood sugar control (HbA1c, daily blood sugars, serum insulin levels, homeostatic assays for insulin sensitivity, and adiponectin [a hormone that suppresses some of the metabolic abnormalities of type 2 diabetes]) were better for the participants on the Mediterranean diet.
- HDL cholesterol increased and triglycerides decreased significantly more in the Mediterranean-diet group; both of these are favorable changes that confer a lower risk for cardiovascular disease.
- Most compellingly, subjects on the Mediterranean diet were able to delay the use of medications by up to three years when compared to those who adhered to the AHA diet.
Although this study was conducted in Italy, where the Mediterranean diet may be more easily adopted by newly diagnosed diabetics, people in the United States – including physicians – are familiar with this nutritional philosophy. Minimal education would be needed to incorporate such a diet into the lifestyles of American patients.
Weight loss remains a keystone in the management of type 2 diabetes. However, new data reinforces the notion that not all methods of weight loss are equal in the long-term maintenance of this disease.
 |
