Study questions the need for endotype-specific diets in diabetes treatment

Study questions the need for endotype-specific diets in diabetes treatment

In a cross-sectional study recently published in the journalNutrition, metabolism and cardiovascular diseases,Researchers in Germany examined adherence to dietary patterns in different diabetes endotypes and their associations with cardiovascular risk factors, kidney function and neuropathy. They found small differences in adherence and associated complications between diabetes endotypes, suggesting insufficient evidence for endotype-specific dietary recommendations.

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People with diabetes face increased morbidity and mortality due to complications such as kidney disease, cardiovascular disease and neuropathy. To manage these risks, dietary interventions such as the Mediterranean diet, dietary approaches to stopping hypertension (DASH), and plant-based diets are recommended. While the Mediterranean and DASH diets have shown positive effects on blood pressure and lipids in patients with type 2 diabetes (T2D), there is still evidence for a plant-based diet. However, studies on their effects on renal function and neuropathy are limited and conflicting. Research on dietary habits has focused on T1D and T2D, overlooking possible differences between diabetes endotypes that differ in risk of complications.

To address this gap, in the present study, researchers examined adherence to specific diets and their association with cardiovascular risk factors, renal function, and neuropathy in five diabetes endotypes: severe autoimmune diabetes (SAID), severe insulin-resistant diabetes (SIRD), severe insulin deficiency diabetes (SIDD), mild obesity-related diabetes (MOD), and mild age-related diabetes (MARD).

About the study

This study included 765 people from the German Diabetes Study (GDS), who were based on a diagnosis of diabetes according to the criteria of the American Diabetes Association. The average age of participants was 48.7 years and 62.1% were male. They were enrolled between 2012 and 2021, either with a known disease duration of less than 12 months at baseline or after participating in the 5-year follow-up study and providing food frequency questionnaire (FFQ) data.

To ensure comparability, the participants were subjected to the same examination at both times. Participants reported their usual consumption behavior of 148 foods in the last 12 months. The intake of nutrients and food groups as well as the average daily total energy were calculated using the German Food Code and the nutrient database. In addition, specific variables necessary for association with diabetes endotypes were collected, including BMI (body mass index), HOMA2-B (homeostatic model assessment), HOMA2-IR (HOMA2 insulin resistance), HbA1c (glycated hemoglobin), and GADA (glutamic acid). Acid decarboxylase antibodies). Outcome variables related to cardiovascular risk factors, renal function and neuropathy, as well as covariates such as age, gender, smoking status, education level and medication use (glucose-lowering, lipid-lowering, antihypertensive agents) were assessed.

Analyzes included association of diabetes endotypes, comparison of dietary adherence, assessment of associations with outcome variables, interaction analyzes using multivariable linear and logistic regression, and sensitivity analyses.

Results and discussion

Of all participants, 35.3% showed the SAID endotype, 2.4% showed SIDD, 5.4% showed SIRD, 27.6% showed MOD and 29.2% showed the MARD endotype. Dietary intake varied by diabetes endotype, with differences observed in frequency of consumption across food groups, including higher meat and dairy intake in SAID and increased red and processed meat consumption in MOD. Differences in dietary pattern adherence were observed across diabetes endotypes, particularly adherence to the Healthy Plant-Based Diet Index (hPDI), with SIDD and MOD showing the lowest adherence and MARD the highest. Results were consistent when only newly diagnosed individuals or those with plausible total daily energy intake were considered.

Dietary pattern adherence showed differential associations with cardiovascular risk factors and neuropathy-related outcomes across different diabetes endotypes. Notably, hPDI was inversely associated with low-density lipoprotein and total cholesterol in people with SAID. In patients with SIRD, closer adherence to the hPDI was associated with lower diastolic blood pressure. In addition, adherence to several dietary habits was found to be inversely associated with high-sensitivity C-reactive protein concentrations in individuals with MARD. In addition, closer adherence to specific dietary habits was associated with a lower risk of peripheral neuropathy and cardiovascular autonomic neuropathy in certain endotypes such as MARD and SAID.

Overall, the study benefits from detailed phenotyping and comprehensive derivation of dietary patterns, taking into account the synergistic effects of individual nutrients and foods. However, the study's recruitment strategy may limit generalizability as certain diabetes endotypes are underrepresented. In addition, dependence on self-reported dietary intake and possible confounding by lifestyle factors may influence results, and alternative methods of diabetes classification may produce different results.

Diploma

In conclusion, the researchers found slight differences in the dietary habits of different diabetes endotypes, suggesting healthier diets in people with MARD and less healthy diets in people with SIDD and MOD. Furthermore, the associations between dietary adherence and diabetes-related outcomes varied by endotype. In the future, longitudinal studies and randomized controlled trials could support the comprehensive assessment of the association between diet and diabetes-related complications within these endotypes. This will help determine the utility of the chosen diabetes reclassification approach in identifying groups that may benefit from tailored nutritional interventions.

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