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Diabetes Care. 2019 Aug;42(8):1390-1397. doi: 10.2337/dc18-2475. Epub 2019 Jun 10.

Effects of a Mediterranean Eating Plan on the Need for Glucose-Lowering Medications in Participants With Type 2 Diabetes: A Subgroup Analysis of the PREDIMED Trial.

Author information

1
Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.
2
Department of Internal Medicine (Endocrinology), Hospital Reina Sofia, Tudela, Spain.
3
Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
4
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.
5
Universitat Rovira i Virgili, Department Biochemistry and Biotechnology, Human Nutrition Unit, IISPV, Reus, Spain.
6
Department of Preventive Medicine, University of Valencia, Valencia, Spain.
7
Cardiovascular Risk and Nutrition (Regicor Study Group), Hospital del Mar Medical Research Institute, Barcelona, Spain.
8
Lipid Clinic, Endocrinology and Nutrition Service, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain.
9
Department of Preventive Medicine, University of Malaga, Malaga, Spain.
10
Institute of Health Sciences, University of Balearic Islands and Son Espases Hospital, Palma de Mallorca, Spain.
11
Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain.
12
Department of Internal Medicine, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain.
13
Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de Las Palmas de Gran Canaria, and Complejo Hospitalario Universitario Insular Materno Infantil (CHUIMI), Servicio Canario de Salud, Las Palmas de Gran Canaria, Spain.
14
Lipid Unit, Department of Internal Medicine, Bellvitge Biomedical Research Institute-Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
15
Department of Cardiology, University Hospital Araba, Vitoria, Spain.
16
Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, Instituto de investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.

Abstract

OBJECTIVE:

To examine the effects of two Mediterranean eating plans (Med-EatPlans) versus a low-fat eating plan on the need for glucose-lowering medications.

RESEARCH DESIGN AND METHODS:

From the Prevención con Dieta Mediterránea (PREDIMED) trial, we selected 3,230 participants with type 2 diabetes at baseline. These participants were randomly assigned to one of three eating plans: Med-EatPlan supplemented with extra-virgin olive oil (EVOO), Med-EatPlan supplemented with mixed nuts, or a low-fat eating plan (control). In a subgroup (15%), the allocation was done in small clusters instead of using individual randomization, and the clustering effect was taken into account in the statistical analysis. In multivariable time-to-event survival models, we assessed two outcomes: 1) introduction of the first glucose-lowering medication (oral or injectable) among participants on lifestyle management at enrollment and 2) insulin initiation.

RESULTS:

After a median follow-up of 3.2 years, in multivariable analyses adjusting for baseline characteristics and propensity scores, the hazard ratios (HRs) of starting a first glucose-lowering medication were 0.78 (95% CI 0.62-0.98) for Med-EatPlan + EVOO and 0.89 (0.71-1.12) for Med-EatPlan + nuts, compared with the control eating plan. After a median follow-up of 5.1 years, the adjusted HRs of starting insulin treatment were 0.87 (0.68-1.11) for Med-EatPlan + EVOO and 0.89 (0.69-1.14) for Med-EatPlan + nuts compared with the control eating plan.

CONCLUSIONS:

Among participants with type 2 diabetes, a Med-EatPlan + EVOO may delay the introduction of new-onset glucose-lowering medications. The Med-EatPlan did not result in a significantly lower need for insulin.

PMID:
31182491
PMCID:
PMC6647050
[Available on 2020-08-01]
DOI:
10.2337/dc18-2475

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