Title: Diet Differs by Type 2 Diabetes Subtype – Insights from EMJ Research

Dietary habits differ significantly across clinical subtypes of type 2 diabetes, according to a new study published in the European Medical Journal (EMJ) and supported by research from the SMART2D cohort. The findings suggest that personalized dietary approaches may improve disease management by aligning eating patterns with specific diabetes classifications.

Researchers analyzed data from 1,007 adults with type 2 diabetes enrolled in the SMART2D cohort, a multi-ethnic Southeast Asian study. Participants had an average age of 61 years (±11), and 52.7% were male. Using factor analysis of 46 food groups from a 125-item food frequency questionnaire, the study identified three predominant dietary patterns: meat, fast food & eat-out; sugar-laden food & drinks; and plant-based & dairy.

• Among individuals with mild age-related diabetes with insulin insufficiency (MARD-II), 40.0% had a predominant plant-based & dairy dietary pattern.
• Both mild obesity-related diabetes (MOD) and severe insulin-resistant diabetes with relative insulin insufficiency (SIRD-RII) showed a predominant sugar-laden food & drinks pattern in approximately 38% of cases, followed by meat, fast food & eat-out in about 31%.
• Compared to MARD-II, both MOD and SIRD-RII were positively associated with the meat, fast food & eat-out pattern and inversely associated with the plant-based & dairy pattern (all P < 0.001).

The study also examined links between dietary patterns and diabetes-related comorbidities. Predominant consumption of sugar-laden food & drinks and meat, fast food & eat-out patterns was differentially associated with health outcomes, particularly in the MOD and SIRD-RII subtypes. These associations were assessed using multivariable regression analysis to account for potential confounding factors.

• The three validated clinical subtypes of type 2 diabetes used in the classification were:
• Mild age-related diabetes with insulin insufficiency (MARD-II)
• Mild obesity-related diabetes (MOD)
• Severe insulin-resistant diabetes with relative insulin insufficiency (SIRD-RII)
• Subtypes were determined using the nearest centroid approach based on clinical characteristics.

The research builds on prior work that identified these subtypes within the same cohort but had not previously characterized their dietary behaviors. By linking specific eating patterns to subtype classifications, the study provides insight into how nutrition interventions might be tailored to individual diabetes profiles.

• No causal relationships were established between dietary patterns and diabetes subtypes or comorbidities, as the analysis was cross-sectional.
• The study population was limited to adults in a multi-ethnic Southeast Asian cohort, which may limit generalizability to other populations.
• Dietary data were self-reported via food frequency questionnaire, which carries inherent risks of recall bias.

• Further research is needed to determine whether modifying dietary patterns according to subtype leads to improved clinical outcomes.
• Longitudinal studies could help clarify whether dietary habits influence subtype progression or vice versa.

• The findings do not constitute medical advice, and individuals should consult healthcare professionals before making dietary changes.