Endocrine Abstracts

Introduction: The importance of good glycaemic control in Type 1 diabetes (T1D), including its association with reduced cardiovascular disease, is well established. Current education programs focus on carbohydrate counting and its matching to the insulin dose. We set out to investigate the association between Mediterranean diet (MD) and the glycaemic control in patients with T1D.

Study design: This was a cross-sectional study that was a collaboration between Cyprus and the UK, which recruited patients with T1D from Limassol, Cyprus. The sample was randomly selected from the database of the Cyprus Diabetes Patients’ Association.

Statistics: The MD was examined for its association with glycaemic control through a predefined multivariate linear (OLS) regression model. The MD was measured through a priori Mediterranean diet score, namely MedDietScore and the glycaemic control through HbA1c and fasting glucose. The covariates were gender, age, BMI, C-peptide, household income, injection method, smoking status and insulin adjustment to carbohydrate intake. Statistics were analysed using STATA 16.0.

Ethics: Ethics approval was received from the Cyprus National Bioethics Committee (EEBK/EII2016/09) and from the University of Stirling, UK (NICR 16/17 – Paper No.44).

Results: The study recruited 103 participants (median age 33 yrs (IQR 26,43); 51 males). Themean MD score was 31.7 (s.d. ± 5.7) points with a median HbA1c at 60 mmol/mol (51,74) and fasting glucose at 168 mg/dl (102,247).

The adherence to the MD was significantly associated with HbA1c [b = −0.015, (–0.026, –0.0045), P = 0.006] but not with fasting glucose. The OLS model predicted a reduction in HbA1c (mmol/mol) by 1.5% for every additional point in the MedDietScore scoring system. A post-hoc analysis indicated that the fasting glucose did not mediate the effect of the MD on the HbA1c: the indirect effect (simple mediation analysis) was not statistically significant (b = −0.0027, P = 0.180) and when fasting glucose was added to the OLS model, the prediction power of MD on HbA1c remained largely unchanged (b = −0.014, P = 0.005).

Conclusion: Patients with T1D in Cyprus appear to have a modest adherence to the MD, with a concerning low uptake in the younger subpopulation. Adherence to the MD was significantly associated with HbA1c and the predicted change was clinically significant. This improvement in HbA1c is more likely mediated via the non-fasting glucose excursions. The adoption of the MD should be encouraged in the structured education programs for T1D.