Impact of vegetarian and non-vegetarian diets on glycaemic control in type 2 diabetes mellitus patients: a cross-sectional study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20254375Keywords:
T2DM, Vegetarian diet, Non-vegetarian diet, Glycemic control, HbA1c, FBS, PPBS, OHAsAbstract
Background: Effective management of type 2 diabetes mellitus (T2DM) requires lifestyle modification alongside pharmacological therapy. Although vegetarian diets have been associated with a lower diabetes burden in Western populations, evidence regarding their effect on glycemic control among Indian patients with T2DM is limited. This study evaluated the association between dietary pattern (vegetarian versus non-vegetarian) and glycemic control in T2DM patients receiving oral hypoglycemic agents (OHAs).
Methods: This cross-sectional study was conducted at a secondary care hospital in Alwar. 200 adults with T2DM were included (115 vegetarians, 85 non-vegetarians). Dietary classification was based on self-reported intake over the preceding 12 months. Fasting blood sugar (FBS), post-prandial blood sugar (PPBS), and glycated hemoglobin (HbA1c) were measured. Baseline demographics, body mass index (BMI), and medication adherence were recorded. Multivariate regression analysis was performed to assess independent association between diet and glycemic control after adjusting for confounders.
Results: Vegetarian patients had significantly lower mean FBS (137.11±25.35 mg/dl versus 161.75±33.93 mg/dl), PPBS (180.24±34.07 mg/dl versus 241.15±52.55 mg/dl), and HbA1c levels (7.47±0.71% versus 8.72±1.42%) compared to non-vegetarians (p<0.001 for all). BMI was comparable between groups (p=0.089). Multivariate analysis showed a vegetarian diet to be independently associated with better glycemic control (OR=2.31; 95% CI: 1.48–3.62; p<0.001). Medication adherence also significantly influenced HbA1c (p=0.012).
Conclusion: Vegetarian diet was associated with improved glycemic control in patients with T2DM, independent of BMI. These findings support dietary modification as an important adjunct to medical therapy, although larger, region-specific studies are needed to guide definitive dietary recommendations.
Metrics
References
Fox CS, Golden SH, Anderson C, Bray GA, Burke LE, de Boer IH, et al. Update on prevention of cardiovascular disease in adults with type 2 diabetes mellitus in light of recent evidence: A scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care. 2015;38(9):1777-803. DOI: https://doi.org/10.2337/dci15-0012
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: A pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016;387(10027):1513-30.
Cheng JS, Tsai WC, Lin CL, Chen L, Lang HC, Hsieh HM, et al. Trend and factors associated with healthcare use and costs in type 2 diabetes mellitus: A decade experience of a universal health insurance program. Med Care. 2015;53(2):116-24. DOI: https://doi.org/10.1097/MLR.0000000000000288
Liggi S, Griffin JL. Metabolomics applied to diabetes—lessons from human population studies. Int J Biochem Cell Biol. 2017;93:136-47. DOI: https://doi.org/10.1016/j.biocel.2017.10.011
Tonstad S, Stewart K, Oda K, Batech M, Herring RP, Fraser GE. Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutr Metab Cardiovasc Dis. 2013;23(4):292-9. DOI: https://doi.org/10.1016/j.numecd.2011.07.004
Satija A, Bhupathiraju SN, Rimm EB, Spiegelman D, Chiuve SE, Borgi L, et al. Plant-based dietary patterns and incidence of type 2 diabetes in US men and women: Results from three prospective cohort studies. PLoS Med. 2016;13(6):e1002039. DOI: https://doi.org/10.1371/journal.pmed.1002039
Aune D, Ursin G, Veierod MB. Meat consumption and the risk of type 2 diabetes: A systematic review and meta-analysis of cohort studies. Diabetologia. 2009;52(11):2277-87. DOI: https://doi.org/10.1007/s00125-009-1481-x
Wallin A, Di Giuseppe D, Orsini N, Patel PS, Forouhi NG, Wolk A. Fish consumption, dietary long-chain n-3 fatty acids, and risk of type 2 diabetes: Systematic review and meta-analysis of prospective studies. Diabetes Care. 2012;35(4):918-29. DOI: https://doi.org/10.2337/dc11-1631
Villegas R, Shu XO, Gao YT, Yang G, Cai H, Li H, et al. The association of meat intake and the risk of type 2 diabetes may be modified by body weight. Int J Med Sci. 2006;3(4):152-7. DOI: https://doi.org/10.7150/ijms.3.152
Kurotani K, Nanri A, Goto A, Mizoue T, Noda M, Oba S, et al. Red meat consumption is associated with the risk of type 2 diabetes in men but not in women: A Japan Public Health Center-based Prospective Study. Br J Nutr. 2013;110(10):1910-8. DOI: https://doi.org/10.1017/S0007114513001128
Erber E, Hopping BN, Grandinetti A, Park SY, Kolonel LN, Maskarinec G. Dietary patterns and risk for diabetes: The multiethnic cohort. Diabetes Care. 2010;33(3):532-8. DOI: https://doi.org/10.2337/dc09-1621
Rock CL, Flatt SW, Pakiz B, Taylor KS, Leone AF, Brelje K, et al. Weight loss, glycemic control, and cardiovascular disease risk factors in response to differential diet composition in a weight loss program in type 2 diabetes: A randomized controlled trial. Diabetes Care. 2014;37(6):1573-80. DOI: https://doi.org/10.2337/dc13-2900
Barnard ND, Scialli AR, Turner-McGrievy G, Lanou AJ, Glass J. The effects of a low-fat, plant-based dietary intervention on body weight, metabolism, and insulin sensitivity. Am J Med. 2005;118(9):991-7. DOI: https://doi.org/10.1016/j.amjmed.2005.03.039
Anderson JW, Ward K. High-carbohydrate, high-fiber diets for insulin-treated men with diabetes mellitus. Am J Clin Nutr. 1979;32(11):2312-21. DOI: https://doi.org/10.1093/ajcn/32.11.2312
Cunha DA, Igoillo-Esteve M, Gurzov EN, Germano CM, Naamane N, Marhfour I, et al. Death protein 5 and p53-upregulated modulator of apoptosis mediate the endoplasmic reticulum stress-mitochondrial dialog triggering lipotoxic rodent and human beta-cell apoptosis. Diabetes. 2012;61(11):2763-75. DOI: https://doi.org/10.2337/db12-0123
Wanders AJ, Alssema M, de Koning EJ, le Cessie S, de Vries JH, Zock PL, et al. Fatty acid intake and its dietary sources in relation with markers of type 2 diabetes risk: The NEO study. Eur J Clin Nutr. 2017;71(2):245-51. DOI: https://doi.org/10.1038/ejcn.2016.204
Bozzetto L, Annuzzi G, Pacini G, Costabile G, Vetrani C, Vitale M, et al. Polyphenol-rich diets improve glucose metabolism in people at high cardiometabolic risk: A controlled randomised intervention trial. Diabetologia. 2015;58(7):1551-60. DOI: https://doi.org/10.1007/s00125-015-3592-x
Harris LLS, Smith GI, Patterson BW, Ramaswamy RS, Okunade AL, Kelly SC, et al. Alterations in 3-Hydroxyisobutyrate and FGF21 metabolism are associated with protein ingestion-induced insulin resistance. Diabetes. 2017;66(7):1871-8. DOI: https://doi.org/10.2337/db16-1475
Yokoyama Y, Barnard ND, Levin SM, Watanabe M. Vegetarian diets and glycemic control in diabetes: A systematic review and meta-analysis. Cardiovasc Diagn Ther. 2014;4(5):373-82.
David LA, Maurice CF, Carmody RN, Gootenberg DB, Button JE, Wolfe BE, et al. Diet rapidly and reproducibly alters the human gut microbiome. Nature. 2014;505(7484):559-63. DOI: https://doi.org/10.1038/nature12820
Kaveeshwar SA, Cornwall J. The current state of diabetes mellitus in India. Australas Med J. 2014;7(1):45-8. DOI: https://doi.org/10.4066/AMJ.2014.1979