Article Text

A journey into a Mediterranean diet and type 2 diabetes: a systematic review with meta-analyses
  1. Katherine Esposito1,
  2. Maria Ida Maiorino2,
  3. Giuseppe Bellastella2,
  4. Paolo Chiodini3,
  5. Demosthenes Panagiotakos4,
  6. Dario Giugliano2
  1. 1Diabetes Unit, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
  2. 2Division of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Second University of Naples, Naples, Italy
  3. 3Medical Statistics Unit, Second University of Naples, Naples, Italy
  4. 4Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
  1. Correspondence to Dr Katherine Esposito; Katherine.esposito{at}


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.


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