Adherence to the Mediterranean diet and its association with glycaemic control in Type 1 diabetes

Abstract

Introduction: The Mediterranean diet (Mdiet) is defined as the dietary patterns of people living around the Mediterranean regions during the 1950s and 1960s. This thesis aimed to investigate the adherence to the Mdiet by Cypriot and Greek populations, and its association with glycaemic control in people with Type 1 diabetes (T1DM) in Cyprus. Methods: Longitudinal adherence to the Mdiet in Cyprus and Greece was explored in a systematic review. The cumulative adherence, stratified by Mdiet scoring systems, was explored alongside the potential age and gender differences. Adherence to Mdiet, glycaemic control and their association (using linear regression models) were investigated in a cross-sectional study among people with T1DM in Limassol, Cyprus. The methodology of this study was tested in a pilot study. Results: The systematic review included 15 independent studies (18 papers). The adherence to the Mdiet was graded as moderate. The KIDMED and the MedDietScore were the most used scores and indicated cumulative mean adherence of 51.6% (4.3 points) and 52.5% (28.9 points), respectively. There was a suggestion of lower adherence in younger ages and a reducing trend over time; no gender difference was observed. For the cross-sectional study, 103 participants were recruited through random sample selection. The mean adherence was 57.6% (31.7 points); 80% and 19% of the participants had a moderate and high adherence, respectively. The median HbA1c and fasting glucose was 65 mmol/mol and 10.3 mmol/l, respectively. Most participants had suboptimal glycaemic control. Mdiet adherence and glycaemic control were poorer in younger ages; no gender difference was observed. The Mdiet was statistically significantly associated with HbA1c but not with fasting glucose, after adjusting for potential confounders. The fully adjusted model predicted a reduction in HbA1c (mmol/mol) by 1.5% for every additional point in the MedDietScore. Conclusion: Mdiet is associated with a clinically and statistically significant reduction of HbA1c in T1DM