Mediterranean Diet for Effective Management of Diabetes: A Literature Review

Running head: EVIDENCE BASED NURSING
Evidence Based Nursing
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Author Note

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Introduction
According to the Australian Institute of Health and Welfare [AIHW] (2018), chronic
diseases are long lasting conditions which are characterised with persistent effects. The social
and the economic consequences of chronic health conditions hamper the health-related
quality of life of the affected individuals. AIHW reports 8 major chronic health conditions
namely asthma, arthritis, cancer, back pain, cardiovascular disease, chronic obstructive
pulmonary disease, diabetes and mental health conditions. This paper will mainly structure its
literature review framework via focusing on the diabetes as a chronic health condition
Research Question
PICOT
P Population Individuals with Diabetes
I Intervention Mediterranean Diet
C Comparison Normal Diet
O Outcome Reduction in glycemic index and effective disease control
Systematic Review
Research Question (100 words)
According to Ryanet al. (2013)diabetes especially type 2 diabetes mellitus is a major
health related problem worldwide. Numerous compelling evidences showed that diabetes can
be prevented by lifestyle changes. The lifestyle modification mainly encompasses
modification of diet which promotes weight loss through restricted calorie intake. Ryanet al.

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(2013) highlighted that Mediterranean diet is moderately rich in fat (fat from vegetable
source) and relatively low in dairy products. This energy is found to promote decreased
incidence of diabetes in comparison to other crash diet or sugar-free diet pattern.
The main research question is how Mediterranean diet plan helps in effective
management of diabetes in comparison to other diet.
Evaluation of the research
Espositoet al. (2014)conducted a primary research in relation to the role of the diet in
controlling type 2 diabetes mellitus. The main aim of the study is to assess the long-term
effects of the dietary interventions on the glycemic control and the requirement of the
diabetes medications and subsequent remission of type 2 diabetes. Espositoet al. (2014) used
two-arm trial design over middle-aged men and women who are over-weight and has recently
been diagnosed with diabetes. The authors randomly allocated the focus group into two
different groups. One in low-carbohydrate Mediterranean diet (LMD) and another group to
low fat diet. This is the main strength of the study design as it allocated randomly the selected
focus groups in to two different groups and accordingly to Brannen(2017), this helps to
decrease the chances of obtaining biased results arising from allocation bias. The two-arm
trial study design further helped to improve the quality of the study (Brannen, 2017).
However, they selected only over-weight men and women in order to check the efficacy of
the Mediterranean diet over the glycemic level and this again stood out for bias selection of
the focus group.The research paradigm selected by the author is positivism research
paradigm. According to Brannen(2017), positivism research paradigm is best suited for the
quantitative research. Espositoet al. (2014) mainly conducted quantitative research as they
used statistical analysis in order to compare the efficacy of LCMD and low fat diet. One

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limitations of the study is, Espositoet al. (2014) used 4 years of follow-up and this lead to the
decrease in the overall sample size which might lead to biased outcome.
Research topic
According to the objective 1of National Strategic Framework for Chronic Conditions,
primary focus should be given on prevention for the promotion of a healthier Australia. The
health promotion and prevention strategies mainly promote minimization or prevention of the
disease progression among the vulnerable population with chronic conditions. Another
implication of objective one is reduction of the risk developing additional conditions and
associated complications along with an improvement of the overall quality of life. According
to Georgoulis, Kontogianni and Yiannakouris(2014),Mediterranean diet helps to minimize
the severity of diabetes mellitus and at the same time helps in the reduction of the glycemic
index of the body. This decreases the overall disease progression. The research conducted by
Sleiman, Al-Badri andAzar(2015) highlighted that observance of Mediterranean diet helps in
the reduction of the development of cardiovascular risk associated with diabetes.
Cardiovascular risk is defined as the macro and microvascular complications which are
associated with diabetes and thus reduction in the risk of developing cardiovascular helps to
decrease the chances of getting affected with the additional disease complications. Thus it can
be said that the research topic mainly aims at the prevention of the disease outcome along
with reduction in the associated health related complication. Thus providing a comprehensive
disease prevention approach.
Literature Review
In relation to the Mediterranean diet Salas-Salvadóet al. (2014)conducted a
multicenter randomised control trial under primary care centres in Spain. The principal aim of
the study is to evaluate whether dietary changes without any strict calorie restriction helps to