Dieta del Mediterráneo y 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 , et al. Annal of Internal Medicine. September 2009 Volume 151 Issue 5 Pages 306-314
Background: Low-carbohydrate and low-fat calorie-restricted diets are recommended for weight loss in overweight and obese people with type 2 diabetes.
Objective: To compare the effects of a low-carbohydrate Mediterranean-style or a low-fat diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes.
Design: Single-center, randomized trial. Randomization was computer-generated and unstratified. Allocation was concealed in sealed study folders held in a central, secure location until participants gave informed consent. Participants and investigators were aware of treatment assignment, and assessors of the primary outcome were blinded.
Setting: Teaching hospital in Naples, Italy.
Patients: 215 overweight people with newly diagnosed type 2 diabetes who were never treated with antihyperglycemic drugs and had hemoglobin A1c (HbA1c) levels less than 11%.
Intervention: Mediterranean-style diet (<50% of daily calories from carbohydrates) (n = 108) or a low-fat diet (<30% of daily calories from fat) (n = 107).
Measurements: Start of antihyperglycemic drug therapy, defined by protocol as indicated for follow-up HbA1c level greater than 7% (primary outcome), and changes in weight, glycemic control, and coronary risk factors (secondary outcomes).
Results: After 4 years, 44% of patients in the Mediterranean-style diet group and 70% in the low-fat diet group required treatment (absolute difference, –26.0 percentage points [95% CI, –31.1 to –20.1 percentage points]; hazard ratio, 0.63 [CI, 0.51 to 0.86]; hazard ratio adjusted for weight change, 0.70 [CI, 0.59 to 0.90]; P < 0.001). Participants assigned to the Mediterranean-style diet lost more weight and experienced greater improvements in some glycemic control and coronary risk measures than did those assigned to the low-fat diet.
Limitations: Investigators responsible for initiating drug therapy were not blinded to treatment assignment. Dietary intake was self-reported.
Conclusion: Compared with a low-fat diet, a low-carbohydrate, Mediterranean-style diet led to more favorable changes in glycemic control and coronary risk factors and delayed the need for antihyperglycemic drug therapy in overweight patients with newly diagnosed type 2 diabetes.

Otros datos:
La dieta mediterránea fue el patrón de alimentación característico de los años 1950 y 1960 en las regiones alrededor del Mar Mediterráneo principalmente el sur de Italia, Creta y otras regiones de Grecia, patrón que ha ido cambiando en los últimos tiempos.
Dicha dieta contiene fundamentalmente Aceite de Oliva como principal grasa culinaria, abundancia de alimentos vegetales como frutas y verduras frescas, cereales, legumbres y frutos secos. Además consumo frecuente de Pescado, vino y se caracteriza por bajo consumo de carnes rojas, leche y derivados y azúcares simples. Por último tenemos un uso frecuente de especias y condimentos variados (limón, ajo, hierbas).

En un trabajo publicado (Sofi F, Cesari F, Abbate R et al. Adherence to Mediterranean diet and health status: meta-analysis. BMJ 2008; 337: a1344. DOI: 10.1136/bmj.a1344 ) se demostró que llevar una dieta como la mediterránea, reduce en un 9 % todas las causas de mortalidad, 9% de reducción de la mortalidad por enfermedades cardiovasculares y 6 % de reducción de la mortalidad por cáncer.
Para reforzar los datos del primer estudio, el estudio de Estruch (Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med 2006; 145(1):1-11. ) demostró que la la dieta mediterránea posee un efecto metabólico muy favorable sobre parámetros generales, mejorando las presiones arteriales sistólica y diastólica, el metabolismo de los carbohidratos, parámetros de colesterol y HOMA, además de mantener el IMC estable.