Relevance of Dietary Patterns for Diabetes-Related Comorbidities in Subgroups of Individuals with Recent-Onset Diabetes

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The classification of diabetes into type 1 (T1D) and type 2 diabetes (T2D) has been questioned and a sub-classification into 5 subgroups based on cluster analysis has been proposed. These subgroups differ in their clinical characteristics and risk of diabetes-related complications. For people with T1D and T2D, increasing evidence suggests that the early disease course might have a profound impact on long-term disease progression and that good metabolic control during the first years after diabetes diagnosis, achieved by targeting e.g. diet, may reduce the development of complications. Although evidence exists for the impact of single dietary patterns on glucose metabolism and, to a lesser extent, for cardiometabolic risk factors in diabetes, evidence for the majority of dietary patterns is scarce and findings are inconclusive, specifically for associations of dietary patterns with microvascular complications. Also, all research has been conducted using the traditional diabetes classification and effects in metabolically more homogenous subgroups, who differ in their risk of complications, has not been studied yet. Based on our previous work (i) investigating the impact of dietary factors for metabolic control and (ii) on determinants of diabetes-related complications during the early time course of T1D and T2D, we now plan to test the following research questions within German Diabetes Study (GDS), classified into the 5 diabetes subgroups, within the first year after diabetes diagnosis as well as 5 years thereafter: (1) Are there differences in hypothesis-based and explorative dietary patterns between the 5 diabetes subgroups at the two examination time points of the GDS? (cross-sectional). (2) Are the differences in hypothesis-based and explorative dietary patterns between the 5 subgroups explained by clustering variables or further parameters of glucose metabolism? (cross-sectional). (3) Are hypothesis-based and explorative dietary patterns also related to cardiometabolic risk factors and intermediate phenotypes of diabetes-related microvascular complications at the two examination time points of the GDS? (cross-sectional). (4) Do associations of hypothesis-based and explorative dietary patterns with cardiometabolic risk factors and intermediate phenotypes of diabetes-related microvascular complications differ between diabetes subgroups? (cross-sectional). (5) Do associations of dietary patterns at baseline with 5-year changes of parameters of glucose metabolism, cardiometabolic risk factors and intermediate phenotypes of diabetes-related microvascular complications differ between diabetes subgroups? (longitudinal). We believe that this project will contribute to an improved understanding of diet and its association with metabolic, cardiovascular and microvascular traits early after diabetes diagnosis and will thus be a further step towards the development of targeted nutritional prevention strategies for diabetes-related complications.