Type 2 diabetes is a serious health condition that commonly results in health decline and an increasing need for medication. However, some studies indicate that dietary intervention can, in fact, not only delay the need for medication but can result in a higher rate of complete remission of diabetes.
Moreover, a dietary intervention replacing carbohydrate for fat, particularly healthy monounsaturated fat such as olive oil, appears to provide greater overall benefits compared to low-fat diets.
In a 4‑year randomized control trial published in the Annals of Internal Medicine, 2009, Esposito and Colleagues compared the effects of a low-carbohydrate Mediterranean diet (LCMD) (less than 50 percent carbohydrate) to a typical low-fat diet (LF) (less than 30 percent fat) on the need for antihyperglycemic medication in patients with newly diagnosed type 2 diabetes.
The trial followed 215 overweight participants with newly diagnosed type 2 diabetes who had never been treated with antihyperglycemic drugs and had HbA1c levels less than 11 percent. Primary outcomes included the start of antihyperglycemic drug therapy, defined by a protocol as indicated for follow-up HbA1c level greater than 7 percent. Secondary outcomes included changes in weight, glycemic control, and coronary risk factors.
After 4 years, only 44 percent of patients in the LCMD group required medication compared to 70 percent in the LF group, LCMD reduced HbA1c by 2 percent compared to LF 1.6 percent, there was higher reduction in serum triglycerides in the LCMD group (23.4 mg/dl compared to 12.6 mg/dl in the LF group), and HDL cholesterol increased in the LCMD group only, by 1.8 mg/dl.
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In 2014, an 8.1‑year follow-up of the original study was published in Diabetes Care to assess the long-term effects of the dietary interventions on primary and secondary outcomes.
After the 8.1‑year follow-up, there was a 2‑year difference for the average time period participants required medication (LCMD 8.1 years, LF 6.1 years). Remission was obtained and sustained at a significantly higher rate in the LCMD group.
Overall the LCMD proved best for achieving a complete remission in type 2 diabetes, with 9.7 percent experiencing at least a 3‑year remission compared to only 2 percent in the LF group, a 5.7 percent remission for 4 years compared to zero percent in the LF group, and a 2.9 percent remission for 5 years compared to zero percent in the LF group.
After conducting the 8.1‑year follow-up study, the authors concluded that:
“In patients with newly diagnosed type 2 diabetes, an LCMD resulted in a greater reduction of HbA1c levels, a higher rate of diabetes remission, and delayed need for diabetes medication compared with a low-fat diet.”
Further to this, Esposito and Colleagues published a detailed systematic review of all meta-analysis and randomized trials that compared a Mediterranean diet with a control diet on the treatment of type 2 diabetes. Published in the British Medical Journal, 2015, the study evaluated 2,824, concluding that:
“The Mediterranean diet was associated with better glycemic 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.”