A MEDITERRANEAN lifestyle could help reduce cardiovascular complications and mortality among people with type 2 diabetes, according to a UK Biobank study.
The findings suggest that adopting a broader Mediterranean lifestyle, extending beyond diet to include physical activity, adequate rest and social connection, may offer an accessible approach to reducing cardiovascular risk in people living with type 2 diabetes.
Researchers analysed data from 3,612 British adults aged 40–70 with type 2 diabetes who participated in the UK Biobank. Participants were followed for a median of 10.5 to 12.1 years.
Adherence was assessed using a modified Mediterranean Lifestyle Index (MEDLIFE), a 25-point score based on information participants provided at baseline between 2009 and 2012.
The three assessed areas were Mediterranean food consumption, made up of 12 food items, Mediterranean dietary habits, including alcohol, sugar and caffeine habits and, finally, physical activity, rest, social habits and conviviality.
During follow-up, 737 participants experienced a major adverse cardiac event (MACE), while 645 died from any cause, and 171 died from cardiovascular disease. MACE included myocardial infarction, ischaemic stroke, heart failure, revascularisation and cardiovascular death.
Participants with the highest MEDLIFE adherence had a 27% lower risk of MACE than those in the lowest adherence group.
The highest adherence group also had a 26% lower risk of death from any cause and a 51% lower risk of cardiovascular death. Each two-point increase in MEDLIFE score was associated with a 12% reduction in MACE risk, a 9% reduction in all-cause mortality, and a 21% reduction in cardiovascular mortality.
The individual components of the lifestyle score also showed associations with outcomes. A two-point increase in the food-consumption component was associated with a 10% lower risk of MACE, while the physical activity, rest and social habits component was associated with 17% lower MACE risk, 14% lower all-cause mortality and 25% lower cardiovascular mortality.
The associations remained broadly consistent across several sensitivity analyses, including analyses excluding early cardiovascular events and participants with MACE at baseline, as well as additional adjustment for dyslipidaemia.
However, the study was observational, meaning that causal relationships cannot be established. Lifestyle behaviours were self-reported, some MEDLIFE components were unavailable, and changes in lifestyle during follow-up could not be assessed.
The researchers also note the potential for residual confounding and limited generalisability due to the UK Biobank’s volunteer-based population.
However, the overall findings highlight the potential importance of a comprehensive Mediterranean lifestyle, rather than dietary changes alone, in supporting cardiovascular health among people with type 2 diabetes.
Reference
Aznar de la Riera M. et al. Mediterranean lifestyle and risk of adverse cardiovascular events, all-cause and cardiovascular mortality among individuals with type 2 diabetes. eClinicalMedicine, 2026; 98
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