The Effects of a Mediterranean Diet on Need for Diabetes Drugs and Remission of Newly Diagnosed Type 2 Diabetes: Follow-up of a Randomized Trial

  1. Dario Giugliano2
  1. 1Diabetes Unit, University Hospital at the Second University of Naples, Naples, Italy
  2. 2Division of Endocrinology and Metabolic Diseases, University Hospital at the Second University of Naples, Naples, Italy
  1. Corresponding author: Katherine Esposito, katherine.esposito{at}


OBJECTIVE To assess the long-term effects of dietary interventions on glycemic control, need for diabetes medications, and remission of type 2 diabetes.

RESEARCH DESIGN AND METHODS Originally, in a two-arm trial design, overweight, middle-aged men and women with newly diagnosed type 2 diabetes were randomized to a low-carbohydrate Mediterranean diet (LCMD; n = 108) or a low-fat diet (n = 107). After 4 years, participants who were still free of diabetes medications were further followed up until the primary end point (need of a diabetic drug); remission of diabetes (partial or complete); and changes in weight, glycemic control, and cardiovascular risk factors were also evaluated.

RESULTS The primary end point was reached in all participants after a total follow-up of 6.1 years in the low-fat group and 8.1 years in the LCMD group; median survival time was 2.8 years (95% CI 2.4–3.2) and 4.8 years (4.3–5.2), respectively. The unadjusted hazard ratio for the overall follow-up was 0.68 (0.50–0.89; P < 0.001). LCMD participants were more likely to experience any remission (partial or complete), with a prevalence of 14.7% (13.0–16.5%) during the first year and 5.0% (4.4–5.6%) during year 6 compared with 4.1% (3.1–5.0%) at year 1 and 0% at year 6 in the low-fat diet group.

CONCLUSIONS In patients with newly diagnosed type 2 diabetes, an LCMD resulted in a greater reduction of HbA1c levels, higher rate of diabetes remission, and delayed need for diabetes medication compared with a low-fat diet.

  • Received December 11, 2013.
  • Accepted February 18, 2014.

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