Association of dietary patterns with diabetes-related comorbidities varies among diabetes endotypes

Background and aims: Differences of dietary pattern adherence across the novel diabetes endotypes are unknown. This study assessed adherence to pre-speci fied dietary patterns and their associations with cardiovascular risk factors, kidney function, and neuropathy among diabetes endotypes. Methods and results: The cross-sectional analysis included 765 individuals with recent-onset (67 %) and prevalent diabetes (33 %) from the German Diabetes Study (GDS) allocated into severe autoimmune diabetes (SAID, 35 %), severe insulin-de ficient diabetes (SIDD, 3 %), severe insulinresistant diabetes (SIRD, 5 %), mild obesity-related diabetes (MOD, 28 %), and mild age-related diabetes (MARD, 29 %). Adherence to a Mediterranean diet score (MDS), Dietary Approaches to Stop Hypertension (DASH) score, overall plant -based diet (PDI), healthful (hPDI) and unhealthful plant -based diet index (uPDI) was derived from a food frequency questionnaire and associated with cardiovascular risk factors, kidney function, and neuropathy using multivariable linear regression analysis. Differences in dietary pattern adherence between endotypes were assessed using generalized mixed models. People with MARD showed the highest, those with SIDD and MOD the lowest adherence to the hPDI. Adherence to the MDS, DASH, overall PDI, and hPDI was inversely associated with highsensitivity C -reactive protein (hsCRP) among people with MARD ( b (95%CI): -9.18 % (-15.61; -2.26); -13.61 % (-24.17; -1.58); -19.15 % (-34.28; -0.53); -16.10 % (-28.81; -1.12), respectively). Adherence to the PDIs was associated with LDL cholesterol among people with SAID, SIRD, and MOD. Conclusions: Minor differences in dietary pattern adherence (in particular for hPDI) and associations with markers of diabetes -related complications (e.g. hsCRP) were observed between endotypes. So far, evidence is insufficient to derive endotype-specific dietary recommendations. Trial registration: Clinicaltrials.gov: NCT01055093. <feminine ordinal indicator> 2024 The Authors. Published by Elsevier B.V. on behalf of The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).