Diabetic microvascular complications, including diabetic retinopathy (DR), diabetic nephropathy (DN), and diabetic peripheral neuropathy (DPN), are important contributors to morbidity and healthcare burden in patients with diabetes. The Mediterranean diet (MD) is associated with improved metabolic health, but its role in attenuating microvascular complications remains unclear. This systematic review and meta-analysis aimed to assess the impact of MD adherence on the risk and progression of these complications.
Methods
We performed a comprehensive search of PubMed, Web of Science, Embase, and Scopus up to February 12, 2025, to identify studies evaluating MD adherence and diabetic microvascular complications. Meta-analyses were performed whenever possible, and effect sizes were reported as odds ratios (OR) or hazard ratios (HR) with 95% confidence intervals (CI).
Results
A total of 14 studies were included, involving 138 to 71,392 participants. Meta-analysis showed that individuals who adhered to MD had a significantly reduced risk of DR (HR: 0.69, 95% CI: 0.49–0.97, p = 0.03; OR: 0.32, 95% CI: 0.12–0.82, p = 0.02). A lower likelihood of developing DN was observed (HR: 0.85, 95% CI: 0.73–0.99, p = 0.04; OR: 0.49, 95% CI: 0.25–0.96, p = 0.04). However, the results for diabetic neuropathy were inconclusive due to study heterogeneity. Sensitivity analyses showed significant heterogeneity, and publication bias was detected in some analyses.
Conclusion
Adherence to the Mediterranean diet was associated with a reduced risk of diabetic nephropathy and retinopathy, supporting its potential as a dietary intervention for diabetes management. However, the evidence for neuropathy remained inconclusive. Well-controlled randomized trials are needed in the future to strengthen causal inferences and refine clinical recommendations for MD-based interventions for diabetic microvascular complications.
Related topics: