Adherence to Mediterranean Diet and Risk of Type 2 Diabetes: An Updated Systematic Review and Dose-Response
Sabina Wallerer1, Julia Stadelmaier1, Eike Floegel1
1Institute for Evidence in Medicine, Medical Center - University of Freiburg/Medical Faculty - University of Freiburg, Freiburg, Germany.
Advances in Nutrition (Bethesda, Md.)
|November 15, 2025
Summary
Following the Mediterranean diet (MedDiet) is linked to a lower risk of developing type 2 diabetes (T2D). This updated review confirms that higher adherence to the MedDiet is a beneficial strategy for T2D prevention.
Area of Science:
- Nutritional Epidemiology
- Preventive Medicine
- Public Health
Background:
- Type 2 diabetes mellitus (T2D) is a growing global health concern.
- The Mediterranean diet (MedDiet) is recognized for its potential in T2D prevention.
Purpose of the Study:
- To systematically review and synthesize current evidence on the association between MedDiet adherence and incident T2D.
- To evaluate the certainty of evidence from randomized controlled trials (RCTs) and prospective cohort studies.
Main Methods:
- Systematic literature search of MEDLINE, Cochrane CENTRAL, and Scopus (2014-2025).
- Inclusion of prospective cohort studies and RCTs examining MedDiet adherence and T2D incidence.
- Random-effects dose-response meta-analyses and risk of bias assessments.
Main Results:
- Analysis of 24 cohort studies and 1 RCT (991,878 participants; 68,325 T2D cases).
- Higher MedDiet adherence showed a moderate-certainty association with reduced T2D risk (HR per 2-point increment: 0.92; 95% CI: 0.90, 0.94).
- Consistent dose-response relationship and robust findings across subgroup analyses.
Conclusions:
- Moderate-certainty evidence supports that increased MedDiet adherence lowers T2D risk.
- Findings reinforce dietary guidelines recommending the MedDiet for T2D prevention.
Related Concept Videos
01:22Diabetes Mellitus: Type 2 and Gestational
4.3K
Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
4.3K
01:36Carbohydrate Metabolism
13.7K
Carbohydrates are polymers composed of molecules containing atoms of carbon, hydrogen and oxygen. One gram of carbohydrate can provide four kilo-calories of energy, which makes it the most efficient instant energy source.
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in...
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in...
13.7K
01:22Diabetes Mellitus: Overview and Type I Subtype
4.8K
Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
4.8K
01:26Atherosclerosis III: Management
307
Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
307
01:15Diabetes: Symptoms, Diagnosis, and Complications
2.0K
For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
2.0K
01:15Diabetes: Management and Pharmacotherapy
853
The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
853