Adherencia a la Dieta Mediterránea en los participantes con Diabetes Mellitus tipo 2 incluidos en el estudio PREDIMED-PLUS, Granada

Abstract

_Type 2 diabetes mellitus (T2DM) is a major global health problem. The prevalence is expected to increase with up to 700 million subjects with T2DM worldwide. Several studies have shown that a nutritional intervention, based on lifestyle modification, with or without physical activity, is able to improve glycaemic control in subjects with T2DM. Objectives_ To analyze the available scientific evidence supporting the effect of a nutritional intervention on glycaemic control in persons with T2DM. To evaluate and analyze the baseline adherence to nutritional recommendations and associated factors in the compliance of participants in the PREDIMED-PLUS study of Granada. Finally, to study the evolution of the recommendations after one year of intervention. Methodology_ To address the first objective, a systematic review and meta-analysis of articles published up to May 2019 corresponding to randomized clinical trials was conducted. For the other objectives, a population of 296 participants with and without T2DM, with metabolic syndrome, without associated complications, aged between 55 and 75 years and with residence in Granada was studied. They were randomized into two possible intervention groups. One group followed the Mediterranean Diet with caloric restriction and the other physical activity and the other only followed the Mediterranean Diet. The Stata 14 package was used for the statistical analyses. Results_ Twenty-eight articles were included in the systematic review and meta-analysis. The results showed a significant improvement in HbA1c levels in the lifestyle modification group compared to usual care. The effects were more pronounced when there was a weight loss greater than 5% and when the intervention combined individual and group sessions. In the participants included in the PREDIMED-PLUS study, Mediterranean Diet basal adherence was similar in individuals with and without T2DM. Being female and physically active was associated with better adherence in participants without T2DM, while in those with T2DM the effect was significant for the presence of a previous diagnosis of hypercholesterolemia. After a follow-up period of six months, a similar improvement was observed in both groups, being superior in the group of participants with T2DM after one year of follow-up. Conclusions_ The available scientific evidence shows that an intervention based on lifestyle modification is more effective than usual care in the management T2DM particularly when there is weight loss. Basal adherence to the Mediterranean Diet is equal in participants with DMT2 and in those with metabolic syndrome without DMT2. The nutritional intervention achieves a significant improvement in compliance of most of the items at six months and one year of follow-up and, therefore, in the total adherence score. This improvement is more pronounced in the participants with T2DM at one year of follow-up. Clinical advice based on the dietary modification supported by the Mediterranean Diet, improves the dietary habits of the participants, regardless of the intervention group, although the effect is greater in the group with an intensive intervention. The results support the need to include the rol of the dietitian-nutritionist specialized in clinical advice in primary care teams as a T2DM prevention and treatment tool_