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

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In a caller cross-sectional study published successful nan diary Nutrition, Metabolism and Cardiovascular Diseases, researchers successful Germany assessed nan dietary shape adherence among different glucosuria endotypes and their associations pinch cardiovascular consequence factors, kidney function, and neuropathy. They recovered insignificant differences successful adherence and associations pinch complications crossed glucosuria endotypes, suggesting insufficient grounds for endotype-specific dietary recommendations.

 nobeastsofierce / ShutterstockStudy: Association of dietary patterns pinch diabetes-related comorbidities varies among glucosuria endotypes. Image Credit: nobeastsofierce / Shutterstock


People pinch diabetes look accrued morbidity and mortality owed to complications for illustration kidney disease, cardiovascular disease, and neuropathy. Dietary interventions, specified arsenic nan Mediterranean diet, dietary approaches to extremity hypertension (DASH), and plant-based diets, are recommended to negociate these risks. While nan Mediterranean and DASH diets person shown benefits successful humor unit and lipids for type 2 glucosuria (T2D) patients, grounds for plant-based diets is still emerging. However, studies connected their effect connected kidney usability and neuropathy are constricted and conflicting. Research connected dietary patterns has focused connected T1D and T2D, overlooking imaginable differences among glucosuria endotypes, which alteration successful complication risk.

To reside this gap, researchers successful nan coming study examined nan adherence to circumstantial diets and their associations pinch cardiovascular consequence factors, kidney function, and neuropathy crossed 5 glucosuria endotypes: terrible autoimmune glucosuria (SAID), terrible insulin-resistant glucosuria (SIRD), terrible insulin-deficient glucosuria (SIDD), mild obesity-related glucosuria (MOD), and mild age-related glucosuria (MARD).

About nan study

In this study, 765 individuals from nan German Diabetes Study (GDS) were included based connected a test of glucosuria according to nan American Diabetes Association criteria. The mean property of nan participants was 48.7 years, and 62.1% were male. They were enrolled betwixt 2012 and 2021, either pinch a known illness long of little than 12 months astatine baseline aliases having participated successful nan 5-year follow-up and provided information from a nutrient wave questionnaire (FFQ).

Participants underwent nan aforesaid introspection astatine some clip points, ensuring comparability. Participants reported their accustomed depletion patterns of 148 nutrient items complete nan erstwhile 12 months. Nutrient and nutrient group intakes and mean full regular power were calculated utilizing nan German Food Code and Nutrient Database. Additionally, circumstantial variables basal for allocation into glucosuria endotypes were collected, including BMI (body wide index), HOMA2-B (homeostatic exemplary assessment), HOMA2-IR (HOMA2- insulin resistance), HbA1c (glycated hemoglobin), and GADA (glutamic acerb decarboxylase antibodies) levels. Outcome variables related to cardiovascular consequence factors, kidney function, and neuropathy were assessed, on pinch covariates specified arsenic age, sex, smoking status, acquisition level, and medicine (glucose-lowering, lipid-lowering, antihypertensive) use.

Analyses included duty of glucosuria endotypes, comparison of dietary shape adherence, appraisal of associations pinch result variables, relationship analyses utilizing multivariable linear and logistic regression, and sensitivity analysis.

Results and discussion

Of nan full participants, 35.3% showed nan SAID endotype, 2.4% showed SIDD, 5.4% showed SIRD, 27.6% showed MOD, and 29.2% showed nan MARD endotype. Dietary intake varied among glucosuria endotypes, pinch differences successful nutrient group depletion frequencies observed, including higher nutrient and dairy intake successful SAID and accrued depletion of reddish and processed nutrient successful MOD. Differences successful dietary shape adherence were observed among glucosuria endotypes, peculiarly successful adherence to nan healthful plant-based fare scale (hPDI), pinch SIDD and MOD showing nan lowest adherence and MARD showing nan highest. Results were accordant erstwhile considering only recently diagnosed individuals aliases those pinch plausible full regular power intake.

Dietary shape adherence showed varied associations pinch cardiovascular consequence factors and neuropathy-related outcomes crossed different glucosuria endotypes. Notably, nan hPDI was inversely associated pinch low-density lipoprotein and full cholesterin among group pinch SAID. Among those pinch SIRD, person adherence to nan hPDI was associated pinch little diastolic humor pressure. Additionally, adherence to aggregate dietary patterns was recovered to beryllium inversely related to high-sensitivity C-reactive macromolecule concentrations among individuals pinch MARD. Furthermore, person adherence to circumstantial dietary patterns was associated pinch little likelihood of peripheral neuropathy and cardiovascular autonomic neuropathy successful circumstantial endotypes, specified arsenic MARD and SAID.

Overall, nan study benefits from elaborate phenotyping and broad derivation of dietary patterns, considering nan synergistic effects of individual nutrients and foods. However, nan study's recruitment strategy whitethorn limit generalizability, pinch nan underrepresentation of definite glucosuria endotypes. Additionally, reliance connected self-reported dietary intake and imaginable confounding by manner factors whitethorn impact nan results, and replacement glucosuria classification methods whitethorn output different outcomes.


In conclusion, nan researchers could place flimsy variations successful dietary patterns among different glucosuria endotypes, suggesting healthier diets successful individuals pinch MARD and little healthful diets successful those pinch SIDD and MOD. Moreover, associations betwixt adherence to dietary patterns and diabetes-related outcomes varied crossed nan endotypes. In nan future, longitudinal studies and randomized controlled tests could assistance nan broad appraisal of nan narration betwixt nutrition and diabetes-related complications wrong these endotypes. This will thief find nan inferior of nan chosen glucosuria reclassification attack successful identifying groups that whitethorn use from tailored nutritional interventions.

Journal reference:

  • Association of dietary patterns pinch diabetes-related comorbidities varies among glucosuria endotypes. Weber, K. S. et al., Nutrition, Metabolism and Cardiovascular Diseases, 34, 911–924 (2024), DOI: 10.1016/j.numecd.2023.12.026,