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Giving CGM Access to All People With Type 2 and Other Diabetes
Leading clinicians at the ATTD conference discussed the need for greater CGM access for people with type 2 diabetes, as well as those with cystic fibrosis-related diabetes.
A panel of internationally renowned clinician-researchers presented data during the opening session of the Advanced Technologies and Treatments for Diabetes (ATTD) conference in Berlin, demonstrating how the use of continuous glucose monitors (CGM) benefits both people with type 2 diabetes and those with cystic fibrosis-related diabetes (CFRD).
While there is no question that there is science to support the use of CGMs for people with type 1 diabetes, the presenters agreed that the jury is still out on the use for type 2 diabetes because there isn’t enough solid evidence yet. They laid out strong arguments that what we do know leans strongly toward better results for type 2 diabetes and a strong call for more research.
In addition, as people with cystic fibrosis are living longer, diabetes is becoming an increasing problem. Citing initial data showing how people with type 2 diabetes and CFRD seem to have improved outcomes with CGM, the panelists strenuously called for increased research to further the understanding and potential adoption of such technology among this population.
The limited data that exists suggest that use of a CGM can make the diagnosis of diabetes earlier, improve outcomes and motivate people to make healthier choices in diet and lifestyle, no matter if they are taking insulin or not.
CGMs for people with type 2 diabetes
Dr. Richard Bergenstal, executive director of the International Diabetes Center at Park Nicollet and clinical professor in the Department of Medicine at the University of Minnesota, began by noting that 90% of those with diabetes have type 2 diabetes and that “all the data is pointing in the right direction” for the expanded use of CGM for those with type 2 diabetes.
Bergenstal addressed the particularly thorny problem of people with type 2 diabetes not on insulin and whether they can be helped by wearing a CGM.
Dr. Lalantha Leelarathna, consultant diabetologist and honorary senior lecturer at Manchester Diabetes Centre, University of Manchester, agreed that CGM use in those with type 2 diabetes is important. As more and more people get diagnosed at earlier ages and they are unable to reach their glucose targets we need a powerful tool like CGMs to help this group do better, he said, given that the earlier someone is diagnosed the longer they will have diabetes and its complications.
He proposed the idea of “eating to target” as a particularly effective way of helping people with type 2 diabetes and the role that CGMs can play in achieving those targets. But, he said, we need a better understanding of how the use of CGM affects self-management.
“There has been a significant shift in how we manage type 2 diabetes,” Leelarathna said, calling it good news. The use of CGMs in type 2 diabetes supports the use of newer treatments with heart and kidney benefits such as SGLT-2 inhibitors and GLP-1 agonists that the data shows are beginning to replace older drugs without such benefits such as sulfonylureas (SFUs) and TZDs.
Dr. Satish Garg, of the Barbara Davis Center for Diabetes at the University of Colorado, went a step further and called for earlier initiation of newer treatments such as tirzepatide. He presented a series of patient stories that illustrated how using CGMs to regularly track glucose levels encouraged changes in eating habits and other behaviors. In combination with the right medication, he said, such technology can be a powerful tool for diabetes management in those with type 2 diabetes, no matter if they are using insulin or not.
“Of course, CGM should be part of diabetes education, management and support for all people striving to live well with diabetes,” Bergenstal said.
Leelarathna joined Bergenstal in calling for more randomized controlled trials to provide additional data showing how CGM use can help people with type 2 diabetes, no matter if they are taking insulin or not.
Leelarathna outlined some needed areas for further study, including more research of CGM use in people with type 2 diabetes who do not use insulin, whether they are on other diabetes medications or not; trying to better understand how CGM affects self-management behaviors such as diet, exercise, sleep and medication adherence; assessing the impact of CGM to quality of life and other patient-reported outcomes; its impact on diabetes complications; considering the impacts of age, ethnicity and social factors on CGM-related outcomes; and how to simplify and enable greater access to and use CGM data to improve people’s lives.
“The evidence so far suggests that CGM may be beneficial in those with type 2 diabetes with both intensive [multiple daily insulin] and basal-only [once-daily] insulin regimens irrespective of residual pancreatic function.” Leelarathna said. While noting that early results have been encouraging, he said, “Further work is needed to establish the full potential and role of glucose sensors [CGM] in the journey of type 2 diabetes treatment.”
Garg also emphasized the importance of access to CGM, particularly in less developed countries, as those are the places in which type 2 diabetes is growing the quickest. The patient stories he shared help put a human face on the importance of advancing the research for people with type 2 diabetes so that patients can do better.
He acknowledged that one of the biggest obstacles to more widespread adoption of the technology beyond its current scope was cost and its ability to be covered by insurance.
“We deal with people from more than the United States and western Europe,” he said, “and I applaud companies such as Abbott for making their Libre system available to the masses.”
CGMs for people with cystic fibrosis
Cystic fibrosis-related diabetes (CFRD) is a type of diabetes that develops in people with cystic fibrosis, a genetic disorder that affects the lungs, pancreas and other organs. Dr. Melissa Putman, an adult and pediatric endocrinologist at Boston Children’s Hospital and Massachusetts General Hospital as well as an assistant professor at Harvard Medical School, spoke about why people with CFRD see health benefits from using CGM.
Putman noted that, like people with type 2 or type 1 diabetes, people with CFRD require careful management of blood sugar levels to avoid complications such as heart disease, kidney disease, and nerve damage. CFRD is a unique form of diabetes that affects about 40,000 people in the United States and about 100,000 worldwide. Life expectancy for people living with CF has increased dramatically over the past few decades, from 33 years in 2001 to 53 years in 2021, but as these people live longer, various complications, such as CFRD, are becoming increasingly prevalent.
Putman explored the role that CGMs could play in people with CF, which have seen significantly better outcomes with new drug therapies that allow them to live longer but, as a result, now must deal with the disease progression that damages the pancreas. There is evidence, she said, that lack of glucose control worsens lung function and that fast blood glucose tests are not effective in identifying glucose variability.
Putman described one of her patients with cystic fibrosis who had a normal A1C of 5.7%, but CGM showed she had multiple highs and lows throughout the day, as shown in the graph below.
“If you use just A1C, you are going to miss this glucose variability,” she said, emphasizing the importance of using CGM. She added that in a study of 20 adults, using the iLet bionic pancreas with the Dexcom G6 improved time in range for the study participants with CFRD, compared to usual care.
Putman also noted that one of the greatest challenges when addressing CFRD is initially screening for diabetes. The CF Foundation currently recommends an oral glucose tolerance test (OGTT) for people with cystic fibrosis over 10 years old. However, rates of annual OGTT testing in adults are very low – only 30% of adults with CF were screened for diabetes. CGM may potentially be an effective tool for expanded screening, she said.
“The screening test will only be helpful if it is actually done,” Putman said. “We are missing opportunities to diagnose these patients early.” CGM may also be helpful, she added, in the ongoing management of CFRD, both with and without AID (automated insulin delivery) technology, as people with this disease are living notably longer lives than they used to.
“This is an exciting and active area,” Putman said, “for research in the application of new diabetes technology to this patient population.”
by Arvind Sommi & Michael Howerton
From diaTribe Learn
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Telemedicine can make diabetes care less expensive and easier to access, but it may not always be a suitable replacement for an in-person visit. Learn what happens during a telehealth visit and see if you could benefit from using telemedicine for your diabetes care. The pandemic upended a lot about life as we knew it. Notably, it was responsible for a 63-fold increase in telehealth visits . For people managing diabetes, however, having a doctor visit over video brings up a host of questions and potential issues. How can a doctor properly check my eyes and feet through a computer screen? Will telehealth replace in-person discussions about my blood sugar? Will I get the same level of care through a computer? According to a 2022 article in American Family Physician , telehealth is promising for diabetes treatment and has been shown to help improve glucose management. In a separate analysis of glucose data from people with type 2 diabetes, people who received remote monitoring of their glucose levels saw significant improvements in A1C over a period of three months. That being said, no study or physician is implying that telehealth fully replaces in-person medical care for diabetes. Here’s what to consider and who might be the best candidates for telediabetes care. What happens during a diabetes telehealth visit? Telediabetes care involves two types of interactions. One is a video meeting with a physician or care team to discuss challenges and potential solutions. During this type of visit, the healthcare provider can see some physical signs or changes, such as rashes or wounds. The second type of interaction is virtual monitoring of glucose levels through a monitoring device that sends data to the care provider. The provider might also follow up with a video call to discuss the data. “Many of the things that are important for diabetes care – blood glucose data review, medication review, insulin teaching – can all happen over video,” said Dr. Varsha Vimalananda, an endocrinologist and associate professor of medicine at Boston University. “CGM data can be uploaded and reviewed remotely, which is also very helpful.” Different providers use different video platforms for telehealth appointments, but most will look and function much like a Zoom call. The benefits of telehealth in diabetes care Not all elements of diabetes care are best suited for telehealth, but many lend themselves naturally to the conversation and convenience that an electronic visit facilitates. For type 2 diabetes in particular, telehealth has been shown to be more effective than in-person care at helping people manage their condition. One reason for the improved outcomes is simply better access to care. Dr. Keta Pandit, an endocrinologist at Texas Diabetes & Endocrinology in Austin, Texas, says continuous glucose monitoring (CGM), along with telehealth options, have changed the landscape of diabetes care. “One of the benefits of being able to offer telemedicine to our patient population is that it has increased the access to care, especially with any ongoing illnesses, hospitalizations, COVID, post-COVID, or any other situations when patients notice their glucose levels are going out of their standard range. Patients often contact us for these types of situations, and we can quickly get them seen via telemedicine to make adjustments to their diabetes medications,” she says. “While this was still an option prior to telemedicine days, the opportunity to see their provider on short notice, not having to worry about transportation, and not having to put in advance notice to take time off of work to travel to the doctor’s office, are some of the ways access to care has increased.” Pandit says this is particularly true for older patients who require frequent visits and women who are pregnant, as well as those who need to optimize their glucose levels before and after surgery. Jasmine Meidas, 51, of Cleveland, Ohio, is one such patient. She was diagnosed with type 2 diabetes 15 years ago. “During the COVID-19 pandemic, I was much more comfortable with telehealth than going into my endocrinologist’s office, which is in a hospital. I still am,” she says. Meidas has a one-hour telehealth visit every three months. “They can order blood work to be taken locally, [and] we review [the results] together. We also review food choices, lifestyle challenges, stressors, and more. We set action steps and goals for the next 90 days,” she says. Meidas periodically sees her endocrinologist in person as well. At Vimalananda’s clinic in Boston, specific groups are making great strides with telehealth options. “Veterans, mostly,” she says. “I have a few [Veteran patients] who have severe [post-traumatic stress disorder]. Driving out to the clinic, dealing with traffic, and navigating the hospital are all things that cause a lot of distress. It’s been a game-changer for them to be able to have the visit from home.” When is telehealth not the best option? “If you have diabetes, please remove your socks and shoes.” This type of sign is frequently displayed in doctors’ offices. How would a foot exam work in telehealth? This is a real concern for people with diabetes, as up to 15% of patients will have a foot ulcer in their lifetime. Pandit and other experts acknowledge the limitations telehealth can have. “The medical team [must depend] on the patient [to provide] data and limited access to other parameters that are needed, including blood pressure measurements or foot examinations. When visits are conducted via telemedicine…care is not as comprehensive,” says Pandit. “There are times when the telemedicine model may pose risks. The limitation is clearly noted in visits with patients who are not technologically savvy, may have hearing issues, or [have] poor [internet] connection at the time of the visit.” Telehealth can also give health care providers a direct view into the home environment, which may result in a patient’s hesitancy to share openly — with family members potentially nearby — and impede the building of relationships and rapport. For these reasons, Pandit recommends that at least every other visit be conducted in person. The future of telediabetes care What if your smart device was smart enough to conduct a virtual eye exam? Checking for diabetic retinopathy, a leading cause of blindness for people with diabetes, is more frequently being included in initial primary care exams, even through telehealth. In one study , over 40% of participants opted for a telehealth version of this initial appointment. “Telemedicine has the power of integrating retinopathy screening and preventative eye care into primary care visits, enabling identification of retinopathy at its early stages and helping patients in reducing financial and quality of life costs incurred by vision loss,” researchers concluded. Until virtual eye exams become more available, Vimalananda says most patients will still need in-person eye and podiatry appointments. For Vimalananda, the future of telehealth depends on increased internet access. The U.S. Census Bureau reported in 2021 that although 92% of households in 2018 had at least one type of computer, only 53% had “high connectivity” (i.e., both a computer or smart device and a broadband internet connection). “āāIf we can ensure universal access to broadband and video-enabled devices, we will be that much further along. Right now, a lot is riding on what happens with respect to policy. During the pandemic, there were major changes made at the federal and state levels to enable easier access to telehealth,” she says. “Patients’ homes were recognized as a place of service [and] providers could practice across state lines. Prior stipulations that telehealth could be provided only in a health care facility, in rural or health professional–shortage areas, and to established patients [were removed]. All that could change very quickly.” The Endocrine Society, along with many other groups, are advocating aggressively in Washington D.C. for comprehensive telehealth reform that would be permanent, she adds. While doctors and patients continue to consider the potential benefits and drawbacks of telediabetes care, it’s key to speak to your own physician about what might work best for you to optimize your care.
W e are delighted to announce a groundbreaking partnership between Diabetic Supplies Inc. and eddii-Care , t he virtual endocrine care clinic hosted by eddii—the leading diabetes management platform. ļ»æ
These protein- and fiber-packed spinach, ricotta, and mozzarella egg muffins are a filling yet healthy weekday breakfast option.
Key takeaways The FDA has issued a warning to users of continuous glucose monitors after reports of missed urgent blood sugar alarms on smartphones. Free apps can act as a backup for CGM alerts on your phone. A secondary alert system, like a CGM receiver or the SugarPixel standalone display, can ensure critical alerts are noticed. The FDA recently issued a safety notice after receiving reports from CGM users who missed critical low and high blood sugar alerts on their smartphones. Some of the causes for the missed alerts included: changes to phone settings, operating system upgrades, and using Bluetooth accessories. The safety warning coincided with my own experience. Following an update to my smartphone, I missed two critical low blood sugar alerts during the night. After missing those notices, I realized that I could back up my CGM alarms the same way I back up photos on my phone or laptop's hard drive. I then went about researching and testing other backup options, including these apps and devices I now use to make sure alarms are heard consistently, especially at night.
Marcia Kadanoff, who lives with type 2 diabetes, shares her top five tips for enjoying a Valentine’s Day meal out. Pink and red hearts everywhere, overpriced dinners, wondering if you’ll have a date (or if you got your partner an appropriate gift) – ah, the joys of Valentine’s Day. I’m stressed just thinking about it. As a person with diabetes, my stress may be a bit different than general Valentine’s Day anxiety. By this point, my spouse knows enough not to get me chocolates, my biggest landmine food. But the hard thing for Valentine's Day or any other romantic occasion is getting a reservation at the right kind of restaurant and – as always when living with diabetes – planning out my meal. Special occasion meals take special skills to navigate. The good news is that there are definitely strategies that can help make a romantic dinner somewhere special enjoyable without diabetes taking center stage. Where I live – the San Francisco Bay Area – many restaurants have Valentine’s Day dinner specials that consist of three to five courses. There’s nothing wrong with eating a multi-course meal, but it does make diabetes management more difficult. From bread to creamy soups and crouton-laden salads to heavy entrées to a dessert that’s potentially cake-filled, multi-course meals can quickly add up to a large amount of carbohydrates, which is a major driver of high blood sugars. The reality is that even if I choose the “healthier” set menu for a celebratory multi-course meal, I still make a point to think about what each portion is bringing (quite literally) to the table. Here are my best tips for navigating a Valentine's Day dinner out.
Figuring out when and how to exercise can be one of the most difficult parts of living with diabetes. Hear from experts who discuss the benefits and share strategies for safely exercising. Having diabetes doesn’t mean you have to let go of the things you love doing, which may include playing sports. Exercise is an essential part of diabetes management, leading to improved weight management, reduction in cardiovascular disease risk factors, and great mental health benefits. Experts like Dr. Lori Laffel, chief of the pediatric, adolescent and young adult section at Joslin Diabetes Center, discussed the benefits and strategies for safely exercising with diabetes. Laffel pointed to the ADA’s Standards of Care, which recommend adults get 150-300 minutes per week of moderate-to-vigorous exercise and youth get 420 minutes per week of moderate-to-vigorous exercise. But even with all of the evidence pointing to its benefits, managing exercise can be one of the most difficult parts of living with diabetes. There are multiple challenges to consider, such as abnormal insulin delivery and glucagon physiology, how stress hormones affect blood glucose, hydration, and more. The good news is that you can still stay active with diabetes and engage in the sports you love. Famous athletes who have diabetes include five-time Olympic gold medalist Gary Wayne Hall Jr., recent Super Bowl champion Noah Gray, and the Women’s National Basketball Association’s 2022 third overall pick Lauren Cox. Exercising just might mean a little more planning on your part. This includes paying special attention to the type of physical activity you’re doing, carb intake, and your insulin regimen, said Laffel. How does exercise impact blood sugar? It’s still difficult to know the degree to which exercise affects your blood glucose levels. According to Michael Riddell, professor of kinesiology and health sciences at York University, an optimal glycemic range is “unclear and very individualized for the athlete with diabetes.” Factors that influence one’s glucose response to exercise include the type of activity, time of day, whether you’ve recently taken insulin, what food was recently consumed, stress, sleep, and more. Athletes who compete may want to consider how their levels vary between training days versus competitions. While it might not always be doable in practice, Riddell recommends a time in range of 70% during training and 75% on competition days – while paying special attention to minimizing hypoglycemia to less than 1%. For competitive athletes, other important things to manage include sleep, meals, basal/bolus insulin, hydration, and workout schedules. The type, duration, and intensity of exercise are main factors that influence glucose response. Different forms of physical activity cause different glycemic trends that ultimately affect how you respond to diabetes management. For example, endurance activities (like walking, jogging, and cycling) tend to reduce glucose levels, whereas high-intensity interval training (HIIT) and resistance training tend to vary more so. Laffel said that if you are engaging in intense exercise, know it can cause hyperglycemia and may increase your insulin needs during recovery time. The amount of carbs you should eat to maintain your desired glucose levels will depend on the intensity of your exercise. Lower-intensity exercise typically means more carbs and less insulin needed and vice versa for higher-intensity exercise, explained Riddell. For context, about 50% of recreational athletes with type 1 diabetes prefer training and sometimes competing with a moderately low (100-200 grams per day), low (40-99 grams per day), or very low (<40 grams per day) carb diet. Helpful guidelines and tech for exercise Activity monitors and devices can significantly help with diabetes management while exercising. Connected pens and insulin pumps provide timely dosage; continuous glucose monitors (CGM) let you follow trends to guide your insulin dosing and carb intake; and automated insulin delivery (AID) can protect you from hypoglycemia and possible hyperglycemia. Laffel provided a few basic guidelines if you’re engaging in aerobic exercise for more than 40 minutes. If you’re on multiple daily injections (MDI) or an open-loop pump, consider the following insulin adjustments: For those on MDI, start with a 20% reduction in basal insulin dose. For people on insulin pump therapy, reduce basal rate by about 50% (as a starting point) 1-2 hours before, during, and about one hour after exercise. Reduce bolus insulin by 50% for meals or snacks two hours before and up to two hours after exercise. At bedtime (or 7-11 hours following afternoon exercise) reduce your basal rate by 20% for up to six hours. If you are engaging in unplanned aerobic exercise, eat a few extra carbs. Use a CGM or monitor to check glucose before, during, and after physical activity. According to Laffel, an overlooked but important part of exercising with diabetes is the cool-down period, which can be any sort of exercise that you consider easy, such as walking or a slow jog. Cooling down can reduce your risk of hyperglycemia after vigorous exercise. You should cool down for about 20 minutes. If your glucose levels remain high, you can consider conservative insulin correction (greater than 220 mg/dL). Ultimately, there are many ways you can tailor diabetes management to work for your exercise plan. You should discuss your exercise regime with your doctor, as everyone’s needs are individualized and dependent on their lifestyle.
Game day is fast approaching. Here are six diabetes-friendly healthy snack recipes that are all sure to be instant crowd-pleasers. Are you ready for the big game? Whether you're a raving football enthusiast, solely a fan of the commercials, or just around for the food and comradery, it's impossible to deny that the Super Bowl is a big deal. It's important to make sure you'll stay healthy while helping yourself to a few delicious bites. “Traditional Super Bowl snack foods are less than ideal, even if you aren't living with diabetes,” says Heather Hanks, a certified nutritionist and medical adviser at Medical Solutions BCN. Hanks acknowledges that it's always a challenge to eat healthy on Super Bowl Sunday. “The key here is to find snacks that contain no refined sugars and fewer carbs, a good source of protein, healthy fats, and fiber to keep you full and stabilize blood sugar levels.” Diabetes-friendly snacks for game day Bearing these pointers in mind, we have six low-carb finger food options, from cheese dips to buffalo-style cauliflower bites. These healthy snack options will have you partaking in the party without feeling too full or weighed down. ļ»æ
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Consuming dark chocolate is linked to a 21% reduction in the risk of developing Type 2 diabetes, while milk chocolate does not offer the same benefit and is associated with weight gain
A while back, I shared some of the advantages of chia pudding, and I’ve since been shocked by the positive response. “Adam, thank you so much,” one diaTribe reader wrote me to say. “I’ve been looking for a breakfast like this for 25 years! It has changed my life.” Parents have even emailed me with enthusiasm for this recipe –“My son loves this!” – meaning this isn’t just a weird concoction for health nuts like me. For those of you who aren’t familiar with the kitchen wonder that is chia pudding, it’s truly the simplest breakfast to make, and it offers so many benefits – little impact on blood glucose, three minutes to make without cooking, inexpensive, stocked with fiber and omega-3s, and filling and tasty – that you might just feel the same way. I’ve walked through how to make it in a video, and for those of you who’d prefer reading the recipe, the written details on how to make chia pudding are also below. What are chia seeds? Chia seeds are the edible seeds of a flowering desert plant, Salvia hispanica, a relative of the mint family. They look a lot like poppy seeds and are packed with fiber, protein, and healthy Omega-3 fats. On their own, chia seeds don’t taste like anything, so it’s all about how they are flavored—hence the recipe. Where to buy chia seeds I buy chia seeds in bulk online; a two-pound bag from Viva Labs on Amazon costs about $10 and covers about 20 breakfasts. They can also be purchased at regular grocery stores, natural foods stores, and even corner stores, usually in one-pound bags. They are often in the baking section or near where bags of rice and beans are sold. They may also be in the bulk foods aisle, near any nuts, or a in health foods and vitamin section as well. How to make chia seed pudding To make chia seed pudding, mix 1/4 cup of chia seeds with 1/2 cup of water . If you’re me, you’ll also add a hearty amount of cinnamon , 1-2 tablespoons of coconut oil , and some combination of toppings such as fruit, seeds, and nuts . (For instance, I like frozen raspberries, shelled sunflower seeds, and almonds.) After about a minute of stirring with a spoon and about a minute sitting , it turns into a pudding-like gel. Chia pudding can also be made ahead of time, and you can double or quadruple the recipe. The water can be hot or cold, depending on your preferences, and the pudding can be made thicker by using less water. Chocolate or vanilla protein powder or pure vanilla extract can be added for additional flavor. There is nothing exact about this recipe, so experiment with the components and toppings to fit your tastes. For example, you can try this Overnight Berry Chia Pudding. I also know someone that makes it with lemon juice, stevia, and almonds. There are many other chia seed pudding recipes on the Internet, though most contain some amount of added sugar, such as honey, maple syrup, date syrup, or coconut sugar. Enjoying chia seed pudding with diabetes When it comes to bolusing for insulin when eating chia pudding, I generally take one unit of insulin for chia seed pudding as I start eating, which covers the very slow blood glucose rise from fat, protein, and the small amount of carbs from the toppings. Each 1/4 cup of chia seeds has 20 grams of carbs, though 16 grams are from fiber (80%), translating to little blood sugar impact. A note about chia seed pudding for people with sensitive stomachs If you have any gastrointestinal discomfort with this recipe, try making the chia pudding in a batch and letting it sit overnight. Some readers have written in to add that soaking chia seeds in water for a longer period of time has made chia seed pudding easier for them to digest. ļ»æ
Key takeaways: U.S. News & World Report has released its 2025 list of best diets, including top-ranked diets for people with diabetes. The list includes nutritious eating patterns such as the Mediterranean diet, the DASH Diet, and the MIND Diet. These dietary eating patterns are optimal for people who are trying to keep blood sugar levels stable. For people living with diabetes, it’s important to eat in ways that help keep blood glucose levels within normal range consistently throughout the day, rather than rapidly fluctuating between figures that are high and low. This often translates to a focus on eating regular, portion-mindful meals that feature lean sources of protein and whole foods plentiful in fiber, along with limiting food or drinks that are high in sugar or simple carbohydrates. U.S. News & World Report issues a list of top diets at the start of each year, with a ranking of their favorites in various health categories, including diabetes and prediabetes. Below are the top four results for the diabetes category, listed in ranked order – plus a bonus honorable mention from the editorial team at diaTribe. While all of these diets – better described as meal patterns – favor whole foods as well as minimize added sugars and refined carbohydrates, their approaches vary. All of these diets, however, have been shown to help improve blood sugar levels while providing adequate nutrition. 1. The Mediterranean diet The Mediterranean eating pattern focuses on consuming an abundance of vegetables, fruits, legumes, beans, nuts, and seeds with low to no red meat intake. It also encourages whole grains, extra virgin olive oil as a main source of healthy fat, moderate amounts of fish rich in omega-3 fatty acids (such as salmon or tuna), and cheese and yogurt . Sweets should be consumed sparingly, if at all. Benefits of the Mediterranean diet Studies have shown that the Mediterranean diet can improve insulin sensitivity, help regulate blood sugar, reduce A1C levels , and lower the risk of type 2 diabetes. Notable health organizations, including the American Heart Association (AHA) and the American Diabetes Association (ADA), have endorsed the Mediterranean diet. What’s more, the Mediterranean diet adds flexibility. “The Mediterranean meal pattern is based on a general pattern of eating that can be adapted to different cultural traditions and food preferences,” said Daisy Seremba, a Georgia-based registered dietitian and certified diabetes care and education specialist. “There are no exclusions of specific foods or food groups, making it easy to follow long term and maintain the health benefits it offers.” Drawbacks of the Mediterranean diet The Mediterranean diet offers many benefits and is an excellent option for most people, but cost may be a concern. “Some consumers report the cost of such things as olive oil, fish, nuts, and seeds may be prohibitive for their budgets,” Seremba said. She recommends shopping for frozen fish or canned varieties, which confer many of the same benefits, as a way to save on the cost of purchasing items such as fresh seafood. Those on the Mediterranean diet may also need to be mindful of carbohydrate content. “Because the Mediterranean diet promotes the intake of fruits, vegetables, and whole grains, people with diabetes may need additional guidance from a registered dietitian or diabetes care and education specialist to ensure they are following their meal plan and limiting their carb intake as needed,” Seremba said. 2. The flexitarian diet The flexitarian eating pattern is a mix between vegan and vegetarian with the flexibility to consume animal products in limited amounts. The majority of foods eaten are plants, nuts, seeds, whole grains, legumes, fruits, and vegetables. It includes three stages: The first stage limits meat to two days per week with no more than 28 ounces per week. The second stage consists of consuming more plant-based foods (eggs and dairy are allowed) three to four times per week, with less than 18 ounces of meat weekly. The third stage limits meat to no more than 9 ounces per week. If you follow the flexitarian diet, you’ll primarily eat plant-based foods, with occasional lean, organic, grass-fed or pasture-raised meat, poultry, eggs, dairy, and fish. Benefits of the flexitarian diet “The flexitarian eating pattern encourages consumption of more plants as the base of the diet with less emphasis on consuming meat, which is more environmentally friendly and healthier in terms of saturated fat content. In addition, a flexitarian diet is higher in fiber, fruits, and vegetables than the typical or standard American diet,” said Sue-Ellen Anderson-Haynes, a registered dietitian and national spokesperson for the Academy of Nutrition and Dietetics. Anderson-Haynes said the flexitarian diet may be a good option for people with diabetes. She pointed to a 2019 study showing that people who closely followed plant-based dietary patterns had a 13% lower risk of developing type 2 diabetes, compared to those who did not strictly follow a plant-based diet. “Plant-based diets, such as the flexitarian diet, are plentiful in fiber, antioxidants, magnesium, and other nutrients that are well documented in research to assist with the prevention and management of chronic illness such as heart disease, cancer, and diabetes,” said Anderson-Haynes. “In terms of managing diabetes, plant-based diets have shown promising results to slow down complications related to diabetes,” Anderson-Haynes said. “Conversely, research reports that diets high in animal protein increase diabetes risk.” Drawbacks of the flexitarian diet The flexitarian diet imposes no limits on the amount of eggs or dairy consumed. "There is no true limit on eggs and dairy as there is with meat, so people following this diet may not know how much of these foods to limit or to consume,” Anderson-Haynes said. 3. The MIND diet The MIND eating pattern, which stands for Mediterranean-DASH Intervention for Neurodegenerative Delay, is a combination of the Mediterranean and DASH eating patterns. The MIND diet encourages people to consume vegetables, nuts, olive oil, whole grains, berries, fish, beans, poultry, and wine in moderate amounts, although newer studies recommend against having any amount of alcohol). Benefits of the MIND diet Both the Mediterranean and DASH eating patterns have been shown to positively impact the management of diabetes and its comorbidities, including high blood pressure, cardiovascular disease (CVD), high blood cholesterol, and obesity. Several studies also suggest that MIND can slow the progression of Alzheimer's disease, although the specific nutritional components responsible for these possible benefits or their mechanism of action haven’t been well studied. “Several studies suggest that healthy fats, like omegas in olive oil and phytochemicals in berries, might be responsible for the neuroprotective effects,” said Sandra J. Arévalo Valencia, a CDCES and director of community health and wellness at Montefiore Nyack Hospital in New York. “In addition to reducing the risk of mental illness, it can help control weight, improve glycemia, improve cholesterol levels, and reduce hypertension,” Valencia said. “MIND doesn’t restrict any food groups, allowing for well-balanced meal plans that can be followed long term without causing any dietary insufficiencies.” Drawbacks of the MIND diet “When talking about MIND with my patients with diabetes, I recommend they exercise caution with the amount of fruit and nuts they consume. Excessive fruit intake could increase glycemia (blood glucose levels),” Valencia said. “In addition, the high fat content of nuts could cause weight gain. The fact that you are eating good fats doesn't take away from the reality that all fats are high in calories.” As with the Mediterranean eating pattern, Aravelo said MIND can be expensive, as ingredients such as fresh berries, olive oil, avocados, salmon, and other recommended foods tend to be costly. 4. The DASH diet DASH – which stands for Dietary Approaches to Stop Hypertension – emphasizes healthy foods like fruits , vegetables, whole grains, lean proteins, and low-fat dairy, while discouraging red meat, added salt, sugar, or saturated fat. This eating pattern is a flexible, heart-healthy diet that can help manage high blood pressure and prevent cardiovascular disease. Eating the DASH way results in a nutrient-dense meal plan high in potassium, calcium, magnesium, fiber, and protein; the ADA has published a consensus report on the effectiveness of the DASH meal plan for people with diabetes. Benefits of the DASH diet In addition to promoting blood pressure control, this eating pattern has been shown to improve insulin resistance, high cholesterol, and obesity, said Kari Garner, a South Carolina-based registered dietitian and CDCES. Garner pointed to a 2022 study that linked the DASH diet to lower mortality risk among individuals with diabetes. “The DASH diet encourages the intake of nutrient- and fiber-rich foods, which can promote weight loss and decrease blood pressure and cholesterol. The DASH diet also has cardiovascular benefits similar to the Mediterranean diet,” Garner said. Drawbacks of the DASH diet One challenge of DASH is that more than 50% of the calories come from carbohydrates, which may be too high for some people with diabetes. DASH carbohydrates may range between 180-270 grams per day, depending on the calorie level. There’s also the challenge of keeping sodium to below 2,300 milligrams (less than 1 teaspoon) per day. “DASH may be hard to sustain due to perceived lack of flavor in foods,” Garner said, adding that limited culinary skills, affordability of fresh ingredients, and lack of an organized support system as other possible impediments to success on DASH. 5. diaTribe honorable mention: The vegan diet This diet, which came in at number seven, didn’t make it to the top of the U.S. News rankings in 2025. Nevertheless, diaTribe believes it deserves special mention for its noted preventative benefits to the heart and liver, parts of the body that are especially important to care for to avoid complications with diabetes, as well as to the gut microbiome. Following a vegan eating pattern means eliminating all animal products from your diet – no meat, fish, or dairy. Some vegans also exclude honey and gelatin from their diet. This eating pattern focuses on primarily eating grains, fruits, vegetables, legumes, nuts, and seeds. While the vegan diet is certainly more limited than a vegetarian diet, there are many new plant-based protein sources offered at grocery stores, restaurants, and even major chains across the U.S. Benefits of the vegan diet Unlike other diets, the vegan diet has fairly straightforward requirements: all plant foods are included. As long as it comes from a plant, you can eat it. There are no strict limits on the number of calories or the amount of food you eat. Vegan diets are generally high in fiber and low in saturated fats, so they fit within a heart-healthy diet and align well with dietary guidelines for people with diabetes. A small study of people with type 1 diabetes found that the vegan diet delivered several benefits, including reduced total daily insulin dose, improved insulin sensitivity, and weight loss. Research suggests following a plant-based diet can reduce the risk of several chronic conditions, including CVD, obesity, and even some cancers. Drawbacks of the vegan diet When you eliminate all animal products from your diet, it can be difficult to get enough of certain nutrients, like vitamin B-12 and iron. Experts recommend taking a certified B12 supplement and consulting with your healthcare provider if you experience any symptoms of B12 deficiency, such as: Cognitive changes like depression, fatigue, and memory impairment Muscle weakness Breathlessness Weight loss Increased heart rate While it’s certainly possible to get enough protein from plant sources, you may have to think creatively at first and explore other options like tofu, tempeh, lentils, plant-based milks, nuts, and seeds. The bottom line: What’s the best diabetes diet for blood sugar management? No eating plan or pattern for diabetes is magical. However, with careful consideration and an understanding of your personal goals, preferences, and capacity to adjust, one of these meal patterns may be right for you. Combining one of these eating patterns with the diabetes plate method – a recommendation of half non-starchy vegetables, one-quarter protein, and one-quarter carbohydrate foods – can help you create balanced, healthy meals and manage blood sugar. Of course, it’s important to combine healthy meals with physical activity to support blood glucose control, maintain a healthy weight, and reduce the risk of diabetes complications. If you’re looking for assistance with meal planning, a registered dietitian and CDCES can help. Here is a helpful database to find a CDCES who can work with you.
