OBJECTIVES: Only a few research studies have investigated the role of diet quality in the management of type 2 diabetes (T2D) when compared to the use of pharmacological treatments. The objective of this study is to examine the impact of diet quality, both with and without pharmacological treatment on the health outcomes of T2D patients.

METHODS: This is a retrospective cross-sectional study that utilized data from the National Health and Nutrition Examination Survey data from 2011–2018. Diet quality was evaluated using the healthy eating index-2015 (HEI-2015) total score which has a scale of 0-100. HEI-2015 score of ≥51 was defined as high-quality diet and <51 as low-quality diet. The independent variable was categorized into 4 groups: high-quality diet with medication (HQDWM), high-quality diet without medication (HQDWOM), low-quality diet with medication (LQDWM), and low-quality diet without medication (LQDWOM). The dependent variables were body mass index (BMI) and hemoglobin A1c (HBA1c). To observe the association between the dependent and independent variables, adjusted quantile regression model was applied to the 10^th, 25^th, 50^th, 75^th, and 90^th percentiles.

RESULTS: Among 2,588 T2D patients, the occurrence of HQDWM, HQDWOM, LQDWM, and LOQDWOM are 36.28%, 14.11%, 34.19%, and 15.42%, respectively. Patients with HQDWOM had significantly lower HBA1c in comparison to patients with HQDWM and LQDWO at the 10^th percentile [Beta=0.50, p-value<0.0001; Beta=0.25, p-value=0.02]. Additionally, patients with HQDWOM had significantly lower BMI when compared to patients with HQDWM, LOQDWO, and LQDWM at the 25^th percentile [Beta=1.62, p-value=0.03; Beta=3.17, p-value<0.0001; Beta=1.70, p-value=0.02]. Similar findings were observed at the 75^th percentile for both outcomes.

CONCLUSIONS: Our findings suggest that HQDWOM is associated with a significantly lower HBA1c and BMI at certain percentiles. The findings of this study will guide providers and payers to develop effective treatment regimens that would be more sustainable and beneficial to T2D patients.