The impact of the Mediterranean diet and close monitoring on glycemic control and weight management in poorly controlled type 2 diabetes

Abstract

Background Despite the increasing availability of medications for managing type 2 diabetes mellitus (T2DM), a significant proportion of patients fail to achieve optimal glycemic control.Objective This study aimed to evaluate adherence to treatment and lifestyle recommendations and their association with achieving diabetes management goals after a 12-month structured follow-up program.Methods In this retrospective cohort study, adults with poorly controlled T2DM (baseline HbA1c >= 10%) who completed a 12-month follow-up were analyzed. The program included close monitoring, structured education, and lifestyle guidance. The Mediterranean Diet Adherence Screener (MEDAS) was employed to evaluate participants' adherence to the Mediterranean diet. The primary outcomes were overall adherence to lifestyle recommendations and its association with variations in HbA1c and body weight.Results The study included 127 patients (58.3% male) with a mean age of 55.4 +/- 10.6 years, and baseline HbA1c of 12.1 +/- 1.8%. At 12 months, 92.1% of patients achieved an HbA1c reduction, with a mean change of -3.8 +/- 2.8% (p < 0.001). Weight loss was observed in 52.8% of patients, with a mean change of -0.9 +/- 8.2 kg (p = 0.064). Medication adherence increased from 52.8% to 84%, but only 22.8% of patients consulted a diabetes specialist dietitian. The mean MEDAS score was 6.4 +/- 1.9, with 26% of patients categorized as low, 66.7% as moderate, and 6.3% as high. MEDAS scores were not associated with changes in HbA1c or body weight (p = 0.248 and p = 0.732 respectively).Conclusion While promoting healthy lifestyle behaviors and medication adherence improves glycemic control in poorly controlled diabetes, adherence to the Mediterranean diet and achieving substantial weight loss remain challenging.