Barrea Luigi, Verde Ludovica, Colao Annamaria, Mandarino Lawrence J, Muscogiuri Giovanna
Dipartimento di Psicologia e Scienze della Salute, Università Telematica Pegaso, Naples, Italy.
Division of Endocrinology, Department of Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA.
Nat Rev Endocrinol. 2025 Aug 15. doi: 10.1038/s41574-025-01161-5.
Type 2 diabetes mellitus (T2DM) is a major global health concern. Medical nutrition therapy has a key role in T2DM management, with dietary interventions being central to improving glycaemic control and overall metabolic health. Growing evidence suggests that certain dietary strategies can exert direct metabolic benefits independent of weight reduction. The Mediterranean diet has consistently demonstrated metabolic and cardiovascular benefits, along with improved glycaemic control, even in the absence of substantial weight reduction. Low-energy and very-low-energy diets, characterized by moderate to severe caloric restriction, respectively, have also been associated with improvements in cardiometabolic markers and glycaemic regulation. Ketogenic diets promote nutritional ketosis and have shown benefits on glycaemic control, insulin sensitivity and other metabolic outcomes, often preceding substantial weight loss. Intermittent fasting strategies, such as alternate-day fasting or the 5:2 model, and time-restricted eating, have likewise been linked to enhanced glycaemic control and favourable metabolic and cardiovascular effects, although their long-term efficacy and safety require further investigation. This Review aims to provide an evidence-based synthesis of the main nutritional strategies used in the treatment of T2DM, with a focus on their underlying mechanisms, clinical efficacy and potential for sustainable long-term implementation.
2型糖尿病（T2DM）是全球主要的健康问题。医学营养治疗在T2DM管理中起着关键作用，饮食干预对于改善血糖控制和整体代谢健康至关重要。越来越多的证据表明，某些饮食策略可以在不依赖体重减轻的情况下产生直接的代谢益处。地中海饮食一直显示出代谢和心血管方面的益处，以及改善的血糖控制，即使在没有显著体重减轻的情况下也是如此。低能量和极低能量饮食，分别以中度至重度热量限制为特征，也与心脏代谢指标和血糖调节的改善有关。生酮饮食促进营养性酮症，并已显示出对血糖控制、胰岛素敏感性和其他代谢结果有益，通常在体重显著减轻之前。间歇性禁食策略，如隔日禁食或5:2模式，以及限时进食，同样与增强的血糖控制和有利的代谢及心血管作用有关，尽管它们的长期疗效和安全性需要进一步研究。本综述旨在对治疗T2DM所使用的主要营养策略进行基于证据的综合分析，重点关注其潜在机制、临床疗效以及可持续长期实施的潜力。
