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A Dietary Approach to Managing Type 2 Diabetes

Adopting a Mediterranean diet in patients with diabetes helps improve glucose levels.     

Managing diabetes can be a challenge when taking into account numerous patient-specific factors like, complexity of the medication regimen, side effect profile of these medications, cost, and lifestyle modifications, which make it harder to successfully control a patient’s diabetes. These factors are usually tied in with the socioeconomic background of the patient, religious beliefs, and cultural awareness. In the United States, diets consist mostly of low fruit and vegetable content, as well as low content of nuts and seeds, with increased content of meats, trans fats, and sodium. The nutritional content of this diet is responsible for the majority of the cases of T2DM. Initially, when managing a patient’s diabetes, diet and exercise is the initial recommendation based on patient’s current clinical presentation; keeping in mind that more uncontrolled cases warrant medication therapy. Therefore, talking to a patient about changes in their diet can be challenging. How do we handle these situations? What is the best diet for a patient? Is it a one-size fits all model? Understanding a patient’s dietary habits, their motivation to get better and what they seek to accomplish can help you obtain a better understanding of what is the best option for managing a patient’s diabetes.

Various studies suggest the use of a Mediterranean diet in patients with diabetes. However, not every patient knows what goes into this diet and what are the benefits behind it. A meta-analysis done by Koloverou and colleagues found that there is a 23% reduction in the risk of developing diabetes, regardless of world region and patient’s health status. In the PRE-DIMED trial, patients on a Mediterranean diet had a 40% reduction in the risk of developing diabetes. Additionally, when obtaining glycemic control in patients with diabetes, it was found that a Mediterranean diet with low carbohydrate content had a higher rate of remission in patients with diabetes, when compared to low-fat content.

Recently, Letois and colleagues studied the effects of a Mediterranean diet on mortality in the elderly population. In this cohort study, baseline characteristics and dietary patterns were obtained for 8,937 patients. Baseline characteristics included: education, income, occupation, smoking status, alcohol intake, history of CVD, BMI, depression, diabetes, hypertension, hypercholesterolemia, dependence, physical activity, self-rated health, number of drugs, and number of chronic diseases. When assessing dietary patterns, researchers focused on fruits and/or vegetables, fish, meat, and olive oil as their four main food consumption groups. These covariates were accounted for and a Cox proportional hazards regression was utilized to explain the association between dietary habits and mortality risk. Participants were followed for 10 years (mean= 8.9 years) and during the study period, 2,016 participants died.

It was found that those who died had history of CVD, vascular risk factors, poor health (self-reported), and smoked or consumed alcohol. The association between the 10-year mortality risk and dietary patterns showed better survival in those individuals who consumed at least 1 fruit and 1 vegetable per day (P=0.03) or at least 4 servings per week (P=0.0005), consumed fish at least 2 servings per week (P=0.01). It was also found that meat consumption in servings greater than 1 per day had a negative effect on survival (P=0.03). Finally, the use of olive oil was found to be inversely correlated with mortality risk only in women (moderate olive oil use: HR 0·80; 95 % CI 0·68, 0·94, P = 0·007; intensive use: HR 0·72; 95 % CI 0·60, 0·85, P = 0·0002).

These findings highlight the potential benefits of a Mediterranean diet in the elderly (>65 y/o). It is important to note that even though there are benefits to this diet, it does not highlight the exact benefits in patients with diabetes. From the study sample, only 855 patients had diabetes and the effects on their disease state are not explained. However, data from previous studies show the potential benefits of this diet with diabetes remission, glycemic control, and incidence of developing diabetes. With this data and on-going efforts, the authors suggest developing nutritional programs with the efforts of increasing public health awareness. More studies should be done to focus on the association between survival, diet, and healthy behaviors in patients with diabetes to get more evidence for the use of this diet.

Practice Pearls:

  • Examine your patient population in order to implement new diet programs and improve health outcomes in diabetic patients.
  • Implementing a Mediterranean diet plan that focuses mostly on fruits, vegetables, fish, and olive oil can help improve mortality rates in the elderly population.
  • Utilizing a Mediterranean diet in patients with diabetes can help improve glycemic levels and potentially decrease the need for medications.


Esposito, Katherine, Maria Ida Maiorino, Giuseppe Bellastella, Demosthenes B. Panagiotakos, and Dario Giugliano. “Mediterranean Diet for Type 2 Diabetes: Cardiometabolic Benefits.” Endocrine (2016): n. pag. Web. 3 Aug. 2016

Esposito, Katherine, Maria Ida Maiorino, Michela Petrizzo, Giuseppe Bellastella, and Dario Giugliano. “The Effects of a Mediterranean Diet on the Need for Diabetes Drugs and Remission of Newly Diagnosed Type 2 Diabetes: Follow-up of a Randomized Trial.” Diabetes Care Dia Care 37.7 (2014): 1824-830. Web. 3 Aug. 2016.

Koloverou, Efi, Katherine Esposito, Dario Giugliano, and Demosthenes Panagiotakos. “The Effect of Mediterranean Diet on the Development of Type 2 Diabetes Mellitus: A Meta-analysis of 10 Prospective Studies and 136,846 Participants.” Metabolism 63.7 (2014): 903-11. Web. 3 Aug. 2016

Letois, Flavie, Thibault Mura, Jacqueline Scali, Laure-Anne Gutierrez, Catherine Féart, and Claudine Berr. “Nutrition and Mortality in the Elderly over 10 Years of Follow-up: The Three-City Study.” British Journal of Nutrition Br J Nutr (2016): 1-8. Web. 3 Aug. 2016


Researched and prepared by Pablo A. Marrero-Núñez – USF College of Pharmacy Student Delegate – Doctor of Pharmacy Candidate 2017 – University of South Florida – College of Pharmacy, reviewed by Dave Joffe, BSPharm, CDE