November 17/Journal of the American Academy of Physician Assistants (JAAPA) -- Clinical question: In overweight patients with newly diagnosed type 2 diabetes, does a Mediterranean-style diet delay the need for antihyperglycemic treatment?
Bottom line: For patients with newly diagnosed diabetes, perhaps we need to pay attention to diet interventions before reaching for the prescription pad. A Mediterranean diet, consisting of grains, poultry, and fish, with a sizeable (>30%) proportion of fat, kept the hemoglobin A1C (Hb A1C) level below 7% in more than 50% of patients for four years after being diagnosed with type 2 diabetes, allowing them to avoid antihyperglycemic therapy. In comparison, a low-fat, higher-carbohydrate diet prevented drug therapy in only 30% of patients. Both diets restricted caloric intake, which is probably at least as important as the diet itself. Both groups received monthly counseling with a dietitian or nutritionist for one year and then every other month from then on, which is a much larger intervention than simply giving patients a diet handout and wishing them the best of luck.