A journey into a Mediterranean diet and type 2 diabetes: a systematic review with meta-analyses

Katherine Esposito, Maria Ida Maiorino, Giuseppe Bellastella, Paolo Chiodini, Demosthenes Panagiotakos, Dario Giugliano, Katherine Esposito, Maria Ida Maiorino, Giuseppe Bellastella, Paolo Chiodini, Demosthenes Panagiotakos, Dario Giugliano

Abstract

Objectives: To summarise the evidence about the efficacy of a Mediterranean diet on the management of type 2 diabetes and prediabetic states.

Design: A systematic review of all meta-analyses and randomised controlled trials (RCTs) that compared the Mediterranean diet with a control diet on the treatment of type 2 diabetes and prediabetic states was conducted. Electronic searches were carried out up to January 2015. Trials were included for meta-analyses if they had a control group treated with another diet, if they were of sufficient duration (at least 6 months), and if they had at least 30 participants in each arm. A random-effect model was used to pool data.

Participants: Adults with or at risk for type 2 diabetes.

Interventions: Dietary patterns that described themselves as using a 'Mediterranean' dietary pattern.

Outcome measures: The outcomes were glycaemic control, cardiovascular risk factors and remission from the metabolic syndrome.

Results: From 2824 studies, 8 meta-analyses and 5 RCTs were eligible. A 'de novo' meta-analysis of 3 long-term (>6 months) RCTs of the Mediterranean diet and glycaemic control of diabetes favoured the Mediterranean diet as compared with lower fat diets. Another 'de novo' meta-analysis of two long-term RCTs showed a 49% increased probability of remission from the metabolic syndrome. 5 meta-analyses showed a favourable effect of the Mediterranean diet, as compared with other diets, on body weight, total cholesterol and high-density lipoprotein cholesterol. 2 meta-analyses demonstrated that higher adherence to the Mediterranean diet reduced the risk of future diabetes by 19-23%.

Conclusions: The Mediterranean diet was associated with better glycaemic control and cardiovascular risk factors than control diets, including a lower fat diet, suggesting that it is suitable for the overall management of type 2 diabetes.

Keywords: DIABETES & ENDOCRINOLOGY; NUTRITION & DIETETICS; PREVENTIVE MEDICINE.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Flow diagram of literature search to identify meta-analyses and randomised controlled trial evaluating the effect of Mediterranean diet in type 2 diabetes and prediabetic states.
Figure 2
Figure 2
Meta-analysis of three long-term RCTs of Mediterranean diet and glycaemic control of diabetes (top panel). The two arms in the RCT by Elhayany were preliminary pooled. Meta-analysis of metabolic syndrome regression by Mediterranean diet (bottom panel). The two arms in the RCT by Babio were preliminary pooled (HbA1c, glycosylated haemoglobin; RCT, randomised controlled trial).
Figure 3
Figure 3
Summary of meta-analyses of Mediterranean diet and HbA1c (top panel), total cholesterol (middle panel) and body weight (bottom panel). *This meta-analysis refers to figure 2 (top panel; HbA1c, glycosylated haemoglobin; RCT, randomised controlled trial).

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Source: PubMed

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