Med Diet delays need for diabetes drugs

In this randomized controlled trial, 108 subjects with newly diagnosed type 2 diabetes were assigned to a Mediterranean-style diet (MED) while 107 were assigned to a low-fat diet based on American Heart Association guidelines.

The MED diet was rich in vegetables and whole grains, low in red meat, had a goal of no more than 50% of calories from complex carbohydrates, and no less than 30% of calories from fat (mainly olive oil). Both diets restricted energy intake to 1800 calories per day for men and 1500 for women, and each group received equal guidance on increasing physical activity. Subjects were followed for up to 4 years to assess the primary outcome of time to introduction of antihyperglycemic drug therapy. Per protocol, drug therapy was initiated when HbA1c exceeded 7% at 2 consecutive 3-month intervals. Secondary outcome measures included changes in weight, glycemic control, lipid levels, and blood pressure.

At the end of the trial, 44% of MED subjects required antihyperglycemic drugs compared with 70% of low-fat diet subjects.

Both groups lost weight, and though the MED group lost significantly more in the first year.

Other measures of glycemic control (changes in level of HbA1c, plasma glucose, serum insulin, HOMA insulin sensitivity, and adiponectin) all favored the MED participants. High-density lipoprotein (HDL) cholesterol increased and triglycerides decreased significantly more in the MED group.

Viewpoint

Current American Diabetes Association guidelines recommend the initiation of metformin immediately upon diagnosis of type 2 diabetes along with lifestyle changes designed to induce weight loss. However, oral antihyperglycemics fail over time, creating the need for ever-intensifying drug regimens. Results of the current study demonstrate that a Mediterranean-style diet can delay the need for antihyperglycemic agents for at least 3 years for most newly diagnosed patients.

This is a truly remarkable finding. Because the current guidelines are focused on weight loss, they recommend either a low-carbohydrate or low-fat calorie-restricted diet. The present study finds clear superiority with a low-carbohydrate approach.

This study suggests that while weight loss may be an important goal for most diabetic patients, how that weight loss is achieved might make a difference in long-term maintenance of glycemic

Annals of Internal Medicine

Steve - we have been blessed with a cornucopia of wonderfully positive diet and lifestyle research recently. It is very encouraging to see.