Dietary strategies for patients with type 2 diabetes in the era of multi-approaches; review and results from the Dietary Intervention Randomized Controlled Trial (DIRECT)
Abstract
Dietary intervention is recognized as a key component in prevention and management of type 2 diabetes (T2DM) and the debate persists: which dietary strategy is most effective. In the Dietary Intervention Randomized Controlled Trial (DIRECT) 322 moderately obese participants were randomized for 2 years to one of three diet groups: low-fat, Mediterranean and low-carbohydrate. Differential effects were observed in the sub-group of patients with T2DM at 24 months: participants randomized to the Mediterranean diet, which had the highest intake of dietary fibers and unsaturated to saturated fat ratio, achieved greater significant improvements in fasting plasma glucose and insulin levels. Patients who were randomized to the low-carbohydrate diet, which had the minimal intake of carbohydrates, achieved a significant reduction of hemoglobin A1C. Although improvements were observed in all groups, the low-fat diet was likely to be less beneficial in terms of glycemic control and lipid metabolism. Interpretation of results from different studies on dietary strategies may be complex since there is often no consistency in diet compositions, calorie restriction, intensity of intervention, dietary assessment or extent of adherence in the trial. Nevertheless, it seems that low fat restricted calorie diets are effective for weight loss and are associated with some metabolic benefits; however, some recent trials have shown that low carbohydrate diets are as efficient in inducing weight loss and in some metabolic measures such as serum triglycerides and HDL-cholesterol may be even superior to low fat diets. When addressing the issue of diet quality rather than quantity applying the glycemic index may have some added benefits. Furthermore special features of the Mediterranean diet have apparent additional favorable effects for patients with T2DM.
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Weight loss as small as 5-10% can substantially improve insulin sensitivity in obese patients.
“since weight loss as small as 5–10% can substantially improve insulin sensitivity in obese patients (16).”
From Leptin and the Central Nervous System Control of Glucose Metabolism (2011) · cites this paper as [16]
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Leptin and the Central Nervous System Control of Glucose Metabolism
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“fat mass) also likely contributes to the overall effects of leptin to improve glucose metabolism, since weight loss as small as 5–10% can substantially improve insulin sensitivity in obese patients (16).”
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- Authors
- Ben-Avraham, S., Harman-Boehm, I., Schwarzfuchs, D., & Shai, I.
- Affiliations
- Shimon Peres Negev Nuclear Research Center (IL)
- Ben-Gurion University of the Negev (IL)
- Corresponding author
- Shai, Iris
- Venue
- Diabetes Research and Clinical Practice
- Publisher
- Elsevier BV
- Published
- 2009-12
- Volume
- 86
- Pages
- S41-S48
- ISSN
- 0168-8227 (ISSN-L)
- OpenAlex
- W2032076884
- Cited by
- 61
- References
- 47
- Citations by year
- 2025: 3 · 2024: 3 · 2023: 1 · 2022: 1 · 2021: 3 · 2020: 8 · 2019: 1 · 2018: 3 · 2017: 1 · 2016: 4 · 2015: 10 · 2014: 3 · 2013: 4 · 2012: 6
- FWCI
- 5.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Research and Clinical Practice (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Keywords
- type 2 diabetes, dietary intervention, Mediterranean diet, low-carbohydrate diet, low-fat diet, glycemic control, HbA1c, fasting blood glucose, insulin, dietary fiber, weight loss, lipid metabolism, glycemic index, diet quality, DIRECT trial
- MeSH terms
- Diabetes Mellitus, Type 2, Diet, Diabetic, Diet, Reducing, Humans, Middle Aged, Obesity, Body Mass Index, Randomized Controlled Trials as Topic, Diet, Fat-Restricted, Diet, Mediterranean
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