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Thursday, November 5, 2009

Mediterranean Diet Delays the Need for Drug Therapy in Type 2 Diabetes

Effects of a Mediterranean-Style Diet on the Need for Antihyperglycemic Drug Therapy in Patients With Newly Diagnosed Type 2 Diabetes: A Randomized Trial

Esposito K, Maiorino MI, Ciotola M, et al
Ann Intern Med. 2009;151:306-314

Study Summary

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). The low-fat diet was rich in whole grains with the goal of no more than 30% of calories from fat and no more than 10% of calories from saturated fat. 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.
Typical of newly diagnosed patients, the study participants averaged 52 years of age, half were men, mean body mass index was about 30 kg/m2, and HbA1c was 7.7%. None of these characteristics differed between groups. At the end of the trial, 44% of MED subjects required antihyperglycemic drugs compared with 70% of low-fat diet subjects. The hazard ratio for time to drug therapy was 0.63 (95% confidence interval, 0.51-0.86), a finding that was essentially unchanged after adjustment for change in body weight. Both groups lost weight, and though the MED group lost significantly more in the first year, there was not a statistically significant difference between groups at the end of the trial. 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.
Source: http://www.medscape.com/viewarticle/711007?src=mp&spon=22&uac=82830HJ

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