Distinct dietary patterns across type 2 diabetes subtypes: Insights from the SMART2D cohort

We previously identified three validated clinical subtypes of type 2 diabetes (T2D) in a multi-ethnic Southeast Asian cohort, but their dietary patterns remained uncharacterised. This cross-sectional analysis explored whether dietary patterns differ across T2D subtypes and examined subtype-specific associations with diabetes-related comorbidities.

Dietary patterns were derived using factor analysis of 46 food groups from 1007 T2D adults (age:61 ± 11 years, 52.7% male) who completed a 125-item food frequency questionnaire. T2D subtypes including 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) were classified using the nearest centroid approach. Each participant's predominant dietary pattern was defined by their highest factor score. Associations between T2D subtypes and dietary pattern scores, and between predominant dietary patterns and comorbidities within each subtype, were assessed using multivariable regression analysis.

Three patterns were identified: meat, fast food & eat-out; sugar-laden food & drinks; and plant-based & dairy. Among MARD-II, 40.0% had a predominant plant-based & dairy pattern, whereas both MOD and SIRD-RII had predominant sugar-laden food & drinks (~38%), followed by meat, fast food & eat-out (~31%) patterns. Compared with MARD-II, MOD and SIRD-RII were positively associated with meat, fast food & eat-out pattern and inversely with plant-based & dairy pattern (all P < 0.001). Predominant sugar-laden food & drinks and meat, fast food & eat-out patterns were differentially associated with comorbidities, particularly in MOD and SIRD-RII.

Our findings suggest distinct dietary intake/patterns and subtype-specific associations with comorbidities in multi-ethnic Southeast Asians with T2D.