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Impact of a Mediterranean Diet and the Glycemic Load of a Diet on Type 2 Diabetes Incidence

Mediterranean diets and low glycemic load diets may provide more benefits than we know….

A recent study used a point system called the Mediterranean Diet Score (MDS) to quantify adherence to/use of a Mediterranean diet (max score of 9) and also assessed the participant’s diet glycemic load (GL) and glycemic index (GI) to further score/quantify their dietary composition. The participant and diet data was gathered from the Greek component of the European Prospective Investigation into Cancer and Nutrition (EPIC) study; the 22,295 non-diabetic, Greek study participants were recruited between 1994 and 1999. Data was analyzed and presented as hazard ratios and 95% confidence intervals from Cox proportional hazards regression models of diabetes. Participants were followed for 234,935 person-years (median follow-up 11.34 years) to assess the incidence of type 2 diabetes development.

The results of the study showed that a high MDS score (>6 compared to <3) was inversely related to diabetes risk (HR 0.88 [95% CI 0.78, 0.99]) and the GL (highest vs. lowest GL quartile) of a diet was positively associated to diabetes (HR 1.21 [95% CI: 1.05, 1.40]). Hence following a Mediterranean and low glycemic load diet may help protect persons from developing type 2 diabetes, reducing their risk by up to 20%.

Eating "healthy" has long been associated with better health but has not yet been quantified in a way that demonstrates its protective mechanisms against development of type 2 diabetes. This study has strong findings that suggest a diet rich in lean protein, vegetables, fruits, and high ratio of monounsaturated fats as opposed to saturated, as well as low alcohol consumption and GL may in fact reduce type 2 diabetes development.

Practice Pearls:

  • Mediterranean diets consist of lean protein (fish/seafood), vegetables, legumes, fruit/nuts, cereals, and a high ratio of monounsaturated to saturated lipid ratios
  • Glycemic index indicates how much a food is expected to raise blood sugar; a high GI index diet will increase insulin demand which in turn can lead to insulin resistance and beta cell dysfunction, leading to type 2 diabetes development.
  • Encouraging patients to eat a Mediterranean based diet and low GI diet may help prevent development of type 2 diabetes.


Rossi, M. et al. Mediterranean diet and glycaemic load in relation to incidence of type 2 diabetes: results from the Greek cohort of the population-based European Prospective Investigation into Cancer and Nutrition (EPIC). Diabetologia (2013) 56:2405–2413