The Role of Mediterranean Diet on Glycated Hemoglobin (HbA1c) in Type 2 Diabetes Mellitus (Literature Review)

Authors

  • Arron Nathaniel Ginting Student
  • Reni Zuraida
  • Eka Putri Rahmadhani
  • Dian Isti Angraini

DOI:

https://doi.org/10.53089/medula.v16i2.1802

Keywords:

Type 2 Diabetes, Mediterranean diet, HbA1c

Abstract

Type 2 diabetes mellitus (DM) is a chronic metabolic disease and global health problem that requires optimal glycemic control to prevent complications. Medical nutrition therapy is a key pillar of management, with the Mediterranean diet recommended due to its nutrient profile rich in unsaturated fats. This review aims to synthesize the latest clinical evidence on the effect of the Mediterranean diet on reducing HbA1c levels in patients with type 2 DM, analyze the underlying biological mechanisms, and evaluate its sustainability compared to other diets. A literature review was conducted using the PubMed database for studies published between 2021 and 2025. Of the 60 articles, 6 clinical studies (RCTs, pilot studies, and prospective interventions) that met the inclusion criteria were analyzed. Data synthesis showed that Mediterranean diet interventions lasting 12 weeks to 12 months consistently reduced HbA1c levels with an absolute reduction range of 0.2% to 2.0% (p < 0.05). Critical interpretation shows that while restrictive diets such as the Ketogenic diet provide more drastic reductions (-9% to -13.5% relative) due to glucose elimination, the Mediterranean diet offers long-term metabolic stability through the restoration of insulin sensitivity. The mechanism of glycemic improvement occurs through anti-inflammatory pathways and modulation of the incretin system, particularly stimulation of the GLP-1 hormone. The Mediterranean diet has been shown to be effective in significantly lowering HbA1c and offers a more sustainable nutritional strategy for patients. Clinical implications suggest the integration of olive oil and plant-based diets as the standard for long-term nutritional therapy.

References

Perkeni, “Pengelolaan dan pencegahan diabetes melitus tipe 2 di indonesia 2024,” 2024.

I. D. F. Global, C. Practice, and M. Type, IDF Global Clinical Practice Recommendations for Managing Type 2 Diabetes 2025. 2025.

Kementerian Kesehatan RI, “Survei Kesehatan Indonesia,” 2023.

N. Adam, Z. Ccfp, S. Reichert, C. Stewart, B. H. Mph, and F. Facpm, “Limitations of hemoglobin A,” vol. 66, pp. 112–114, 2020.

N. Hussain, “Implications of using HBA1 C as a diagnostic marker for diabetes,” Diabetol. Int., vol. 7, no. 1, pp. 18–24, 2025, doi: 10.1007/s13340-015-0244-9.

M. Alssema et al., “Diet and glycaemia : the markers and their meaning . A report of the Unilever Nutrition Workshop British Journal of Nutrition,” pp. 239–248, 2015, doi: 10.1017/S0007114514003547.

M. P. Silvestre et al., “A Pilot Study on the Metabolic Impact of Mediterranean Diet in Type 2 Diabetes : Is Gut Microbiota the Key ?,” pp. 1–15, 2021.

C. D. Gardner et al., “Effect of a ketogenic diet versus Mediterranean diet on glycated hemoglobin in individuals with prediabetes and type 2 diabetes mellitus : The interventional Keto-Med randomized crossover trial,” pp. 640–652, 2022.

W. Currenti et al., “Comparative Evaluation of a Low-Carbohydrate Diet and a Mediterranean Diet in Overweight / Obese Patients with Type 2 Diabetes Mellitus : A 16-Week Intervention Study,” 2024.

C. R. Ivan et al., “Italian Ketogenic Mediterranean Diet in Overweight and Obese Patients with Prediabetes or Type 2 Diabetes,” pp. 1–17, 2022.

S. Ismael et al., “A pilot study on the metabolic impact of mediterranean diet in type 2 diabetes: Is gut microbiota the key?,” Nutrients, vol. 13, no. 4, pp. 1–15, 2021, doi: 10.3390/nu13041228.

V. Palmas et al., “Impact of Ketogenic and Mediterranean Diets on Gut Microbiota Profile and Clinical Outcomes in Drug-Naïve Patients with Diabesity : A 12-Month Pilot Study,” pp. 1–40, 2025.

T. P. Minari et al., “The Impact of a Nutritional Intervention on Glycemic Control and Cardiovascular Risk Markers in Type 2 Diabetes,” 2024.

V. A. Ruiz-Pozo et al., “The role of the Mediterranean diet in prediabetes management and prevention: a review of molecular mechanisms and clinical outcomes,” Food Agric. Immunol., vol. 35, no. 1, pp. 1–17, 2024, doi: 10.1080/09540105.2024.2398042.

T. Milenkovic et al., “Inspiration for the Scientific World . A Review,” Nutrients, pp. 1–19, 2021, [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/33920947/

S. Ozsoy, N. Sultanoglu, and T. Sanlidag, “The role of Mediterranean diet and gut microbiota in type-2 diabetes mellitus associated with obesity (diabesity),” J. Prev. Med. Hyg., vol. 63, no. 2, pp. E87–E92, 2022, doi: 10.15167/2421-4248/jpmh2022.63.2S3.2751.

X. Yu, H. Pu, and M. Voss, “Overview of anti-inflammatory diets and their promising effects on non-communicable diseases,” Br. J. Nutr., vol. 132, no. 7, pp. 898–918, 2024, doi: 10.1017/S0007114524001405.

R. Kamakura, G. S. Raza, N. Sodum, V. P. Lehto, M. Kovalainen, and K. H. Herzig, “Colonic Delivery of Nutrients for Sustained and Prolonged Release of Gut Peptides: A Novel Strategy for Appetite Management,” Mol. Nutr. Food Res., vol. 66, no. 19, pp. 1–11, 2022, doi: 10.1002/mnfr.202200192.

G. Carullo et al., “GPR120/FFAR4 Pharmacology: Focus on Agonists in Type 2 Diabetes Mellitus Drug Discovery,” J. Med. Chem., vol. 64, no. 8, pp. 4312–4332, 2021, doi: 10.1021/acs.jmedchem.0c01002.

R. E. Kuhre, C. F. Deacon, J. J. Holst, and N. Petersen, “What Is an L-Cell and How Do We Study the Secretory Mechanisms of the L-Cell?,” Front. Endocrinol. (Lausanne)., vol. 12, no. June, pp. 1–19, 2021, doi: 10.3389/fendo.2021.694284.

Y. Yamamoto et al., “Oral administration of linoleic acid immediately before glucose load ameliorates postprandial hyperglycemia,” Front. Pharmacol., vol. 14, no. July, pp. 1–9, 2023, doi: 10.3389/fphar.2023.1197743.

S. C. Chong, N. Sukor, S. A. Robert, K. F. Ng, and N. A. Kamaruddin, “Fasting and stimulated glucagon-like peptide-1 exhibit a compensatory adaptive response in diabetes and pre-diabetes states: A multi-ethnic comparative study,” Front. Endocrinol. (Lausanne)., vol. 13, no. September, pp. 1–15, 2022, doi: 10.3389/fendo.2022.961432.

A. Di Mauro et al., “The Mediterranean diet increases glucagon-like peptide 1 and oxyntomodulin compared with a vegetarian diet in patients with type 2 diabetes: A randomized controlled cross-over trial.,” Diabetes. Metab. Res. Rev., vol. 37, no. 6, p. e3406, Sep. 2021, doi: 10.1002/dmrr.3406.

J. I. Lukito, “CONTINUING PROFESSIONAL DEVELOPMENT Akreditasi PP IAI-2 SKP Tinjauan atas Glucagon-like Peptide-1 Receptor Agonist,” vol. 47, no. 6, pp. 448–454, 2020.

Published

2026-02-05

How to Cite

Ginting, A. N., Zuraida, R., Putri Rahmadhani, E. ., & Isti Angraini, D. . (2026). The Role of Mediterranean Diet on Glycated Hemoglobin (HbA1c) in Type 2 Diabetes Mellitus (Literature Review). Medical Profession Journal of Lampung, 16(2), 170-175. https://doi.org/10.53089/medula.v16i2.1802

Issue

Section

Artikel