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Distinct dietary patterns across type 2 diabetes subtypes: Insights from the SMART2D cohort
Mei Chung Moh1, Tsz Kiu Kwan1, Jun Shi Lai2
1Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore.
European Journal of Clinical Nutrition
|April 22, 2026
Summary
Dietary patterns vary across type 2 diabetes (T2D) subtypes in Southeast Asians. Specific diets are linked to different comorbidities, highlighting the need for personalized T2D management strategies.
Area of Science:
- Endocrinology
- Nutritional Science
- Public Health
Background:
- Type 2 diabetes (T2D) exhibits clinical heterogeneity, with three subtypes identified in a multi-ethnic Southeast Asian cohort: mild age-related diabetes with insulin insufficiency (MARD-II), mild obesity-related diabetes (MOD), and severe insulin-resistant diabetes with relative insulin insufficiency (SIRD-RII).
- Dietary patterns associated with these T2D subtypes and their link to comorbidities remained uncharacterized.
Purpose of the Study:
- To investigate differences in dietary patterns among the three T2D subtypes.
- To examine subtype-specific associations between dietary patterns and diabetes-related comorbidities.
Main Methods:
- Cross-sectional analysis of 1007 T2D adults using a 125-item food frequency questionnaire.
- Factor analysis identified three dietary patterns: meat, fast food & eat-out; sugar-laden food & drinks; and plant-based & dairy.
- Multivariable regression assessed associations between T2D subtypes, dietary patterns, and comorbidities.
Main Results:
- The MARD-II subtype predominantly followed a plant-based & dairy pattern (40.0%).
- MOD and SIRD-RII subtypes predominantly consumed sugar-laden food & drinks (~38%) and meat, fast food & eat-out (~31%) patterns.
- MOD and SIRD-RII showed positive associations with meat/fast food patterns and inverse associations with plant-based/dairy patterns compared to MARD-II (P < 0.001).
- Specific dietary patterns were differentially associated with comorbidities within MOD and SIRD-RII subtypes.
Conclusions:
- Distinct dietary patterns characterize T2D subtypes in multi-ethnic Southeast Asians.
- Dietary patterns are associated with specific comorbidities in a subtype-dependent manner, underscoring the importance of personalized nutrition in T2D management.
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