Search Results (163)

Dumping Syndrome (DS) is a significant complication following bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB). This condition is characterised by gastrointestinal and vasomotor symptoms resulting from altered anatomy and hormonal dysregulation, notably accelerated gastric emptying and an exaggerated release of gut peptides. Based on the timing of symptom onset after food ingestion, DS is classified as early (EDS) or late (LDS). The critical roles of peptides such as GLP-1, GIP, insulin, and YY peptide are highlighted, along with the involvement of neuroendocrine pathways in symptom manifestation. Diagnosis relies on a combination of clinical evaluation and dynamic testing, with the oral glucose tolerance test (OGTT) often considered a key reference standard for diagnosis. Initial management involves dietary modifications, emphasising the glycaemic index of foods and meal distribution. In cases where nutritional interventions are insufficient, pharmacotherapy with agents such as acarbose, somatostatin analogues (octreotide and pasireotide), GLP-1 receptor agonists (liraglutide), calcium channel blockers (verapamil), and emerging therapies, including herbal medicine, may be considered. For refractory cases, surgical options like bypass reversal or partial pancreatectomy are reserved, although their efficacy can be variable. Despite advancements in understanding and treating DS, further large-scale, randomised controlled trials are essential to validate novel strategies and optimise long-term management. This review provides an updated and comprehensive overview of the aetiology, pathophysiological mechanisms, diagnostic approaches, and current management strategies for DS. Full article

Background: There is a worldwide increase in the prevalence of type 2 diabetes, and strategies for managing this condition include dietary interventions. These interventions include the use of a low-glycaemic index diet, high-fibre and prebiotic diets, and low-carbohydrate diets (LCDs), which improve glycaemic control, reduce the risk of diabetic complications, and promote health. However, the definition of LCDs varies across the literature, and the use of LCDs in managing people with diabetes is often seen as controversial. Therefore, the aim of this review is to examine current advances and future prospects in the use of LCDs in managing people with type 2 diabetes. Method: A systematic review of randomised controlled trials, which applied both the PRISMA and PICOS frameworks. Databases including MEDLINE, APA PsycInfo, Academic Search Premier, CINAHL Plus with Full Text, APA PsycArticles, and Psychology and Behavioural Sciences Collection were searched through EBSCOHost. The EMBASE database and reference list of articles were also searched for articles of interest. Two researchers conducted the searches independently from database inception to 28 August 2025. However, based on the inclusion criteria, the year of publication of studies was restricted to articles published from 2021. The search terms were combined using Boolean operators (AND/OR), and duplicates were removed in EndNote. The articles were screened for eligibility based on inclusion and exclusion criteria by two researchers. Results: The findings identified that an LCD is significantly (p < 0.05) more effective in reducing glycaemic parameters compared to a usual diet, standard care, or a control diet in people with type 2 diabetes. Similarly, the effect of LCD was significant (p < 0.05) in reducing BMI in patients with type 2 diabetes compared with the control diet. However, an LCD did not appear to have a significant (p > 0.05) effect on lipid parameters compared to a control diet. Conclusion: This systematic review found that LCDs are significantly (p < 0.05) more effective in promoting glycaemic control than a usual diet, standard care, or a control diet in people with type 2 diabetes. In addition, LCDs can be an effective strategy for reducing BMI in individuals with type 2 diabetes, particularly when implemented as part of a structured, sustained dietary intervention. However, there was variability in the findings of the studies included with respect to glycaemic control and BMI. Furthermore, the impact of LCD on glycaemic control did not appear sustainable in the long term. LCDs did not have a significant (p > 0.05) effect on lipid parameters compared to a control diet. Full article

The milling process is a critical technological step that regulates wheat flour characteristics and ultimately determines end-product quality. This study systematically evaluated the effects of three key milling parameter adjustments in a laboratory-scale roller mill—double sifting (2S), double break milling (2BM), and increased roll gap (IRG)—on the physicochemical properties of wheat flour and the quality of microwave freeze-dried non-fried instant noodles. The results demonstrated that milling processes significantly influenced the particle size and composition of flour. The 2BM-IRG process increased the volume mean diameter of flour to 86.38 μm, while significantly improving flour extraction rate (69.80%), protein content (10.98%), and ash content (0.54%). In contrast, the 2S process significantly reduced the volume mean diameter (65.27 μm). These changes in flour properties directly affected noodle quality—noodles made from 2BM-IRG flour exhibited the highest rehydration ratio but also the greatest cooking loss, along with the lowest expected glycaemic index (eGI); noodles produced from 2S flour showed the highest hardness, while the 2BM process endowed noodles with superior elasticity. A correlation analysis revealed that the digestibility characteristics of noodles (eGI) were predominantly and significantly influenced by flour protein and ash content (p < 0.01), while also being significantly affected by particle size (p < 0.05). The study confirmed distinct quality trade-offs between different milling strategies. Therefore, by optimizing combinations of break milling and sifting processes, it is possible to develop specialized flour tailored for specific quality requirements. Full article

Background: Sex differences in type 2 diabetes (T2D) are a growing area of diabetes research. No data have been reported on sex differences with oral semaglutide (oSEMA) in a real-world setting. Methods: We included people with T2D who started treatment with oSEMA in routine clinical practice between November 2021 and November 2022, with at least one report of clinical follow-up (FU) data at 3 months. We evaluated in women with T2D (WWT2D) the clinical effectiveness of oSEMA and factors associated with clinical response and persistence. We also analyzed differences in baseline characteristics, clinical effectiveness, persistence rates and safety according to biological sex. Results: Of the 1018 subjects [median age: 63 years, body mass index (BMI): 33.8 kg/m², HbA1c: 7.8%], 469 were WWT2D. In WWT2D, oSEMA reduced HbA1c by 0.7% [−0.1 to −1.3] and 0.9% [−0.2 to −1.5] at the 6- and 12-month FU visits, while weight decreased by 4.6% [2.0 to 7.9] and 7.2% [2.5 to 10.9], respectively. Weight loss was >10% in 29.8% of WWT2D (95% CI 25.8 to 34.1); meanwhile, the combined endpoint (HbA1c decrease ≥ 1% + weight reduction ≥ 5%) was achieved in 23.5% (95% CI 19.8 to 27.5%) of WWT2D at the 12-month FU visit. Achievement of glycaemic targets was similar in women and men (59.3% vs. 61.1%). We found no sex differences in weight loss (6.9% vs. 6.8%), oSEMA maintenance dose, persistence rate (76.3% vs. 77.3%), or adverse events. Conclusions: oSEMA was effective and safe in WWT2D in a real-world setting, with nearly one-third of patients reporting weight loss >10% and more than two-thirds achieving HbA1c < 7%. oSEMA showed no sex bias in terms of effectiveness and safety. Full article

Type 2 diabetes mellitus (T2DM) remains a significant global public health concern, largely driven by poor dietary habits, physical inactivity, and rising obesity rates. In recent years, personalised nutrition (PN) emerged as a promising approach to T2DM prevention and management. This narrative review synthesises current evidence on tailored dietary strategies, including the glycaemic index (GI), glycaemic load (GL), food insulin index (FII), and precision nutrition tools. It further explores their impact on glycaemic control, insulin sensitivity, and adherence to dietary interventions. A structured review of peer-reviewed and grey literature was conducted, taking into account behavioural, cultural, and systemic implementation factors. Although evidence supports the efficacy of PN in improving metabolic outcomes, implementation in low- and middle-income countries (LMICs) remains limited due to infrastructural, financial, and contextual challenges. This review emphasises the need for context-specific, scalable solutions integrated into primary healthcare systems. Full article

Biscuits are widely consumed snacks traditionally made from wheat flour, which poses challenges for individuals with gluten intolerance and/or diabetes due to their high glycaemic index (GI). This study explored the production of gluten-free biscuits using rice flour from two varieties, Type III (Basmati) and Ariete (Long A), incorporating varying proportions of rice bran as a substitute for milled and brown rice flour. Results show that biscuits made with rice bran had lower starch digestibility and reduced GI (57.06–62.75) compared to control biscuits (66.23–66.95). Rice bran also increased bioactive compounds, such as phytic acid (0.16 to 1.96 g/100 g), γ-oryzanol (0.20 to 86.56 mg/100 g), and γ-aminobutyric acid (6.78 to 16.23 mg/100 g), known for their benefits to diabetes metabolism. Physicochemical analysis further revealed higher protein (6.49%) and lower starch content (30.07%) in rice bran biscuits than in control biscuits (4.20% and 47.38%, respectively). The control biscuits exhibited the highest spread ratio (5.90 and 6.35) and the Ariete variety produced less brittle biscuits (168.30 N), although the addition of bran increased brittleness under cutting force (54.55 N). Sensory evaluation of four rice biscuit formulations showed no significant differences in consumer preferences, regardless of flour type, bran proportion, or rice variety. Among the formulations, the Type III biscuits with an equal blend of milled flour and rice bran stood out, offering improved nutritional quality and a promising option for gluten-free, low-GI diets for consumers seeking healthier alternatives. This formulation also proved a strong balance across key nutritional and bioactive parameters, when compared to a commercial wellness biscuit. Full article

Confectionery products, particularly caramel, often have low nutritional value and a high glycaemic index, necessitating the development of functional alternatives. This study aimed to create candy caramel with a reduced glycaemic index and enhanced nutritional properties by incorporating isomaltitol and invert syrup as sugar substitutes and fortifying it with dried barberry (Berberis vulgaris L.) powder in amounts of 1%, 2.5%, 5%, and 10% (w/w). Barberry powder, rich in bioactive compounds and essential minerals, also acts as a natural colourant. The powder’s microstructural characteristics were assessed using laser diffraction, while its elemental composition was confirmed via atomic adsorption spectroscopy. The samples of caramel were evaluated using physicochemical and sensory analysis methods. The results showed that the addition of barberry powder enriches caramel with sodium, potassium, iron, manganese and zinc. The increase in the content of barberry in sweets was accompanied by an increase in titratable acidity and a decrease in pH. Sensory evaluation identified 2.5–5% barberry powder as optimal, yielding a product with attractive colour and flavour. Higher concentrations resulted in excessive acidity and darker coloration, which were deemed undesirable. The developed formulation demonstrates the potential of candy caramel as a functional food product, offering improved nutritional and sensory attributes. This approach provides a promising solution for addressing the health and dietary concerns associated with traditional confectionery products. Full article

Background and Objectives: Maternal dyslipidaemia and low-grade inflammation are recognised drivers of in utero vascular remodelling, yet composite dynamic markers that integrate lipid–glycaemic, inflammatory and endothelial signals have not been evaluated. We investigated whether eight-week trajectories in the triglyceride–glucose index (TyG), interleukin-6 (IL-6) and flow-mediated dilation (FMD) outperform single-timepoint lipids for predicting fetal aortic remodelling. Materials and Methods: In a prospective repeated-measures study, 90 singleton pregnancies were examined at 24–26 weeks (Visit-1) and 32–34 weeks (Visit-2). At each visit, we obtained fasting lipids, TyG index, hsCRP, IL-6, oxidative-stress markers (MDA, NOx), brachial flow-mediated dilation (FMD), carotid IMT and uterine-artery Doppler, together with advanced fetal ultrasonography (abdominal-aorta IMT, ventricular strain, Tei-index, fetal pulse-wave velocity). Mothers were grouped by k-means clustering of the visit-to-visit change (Δ) in TG, TyG, hsCRP, IL-6 and FMD into three Metabolic-Inflammatory Response Phenotypes (MIRP-1/2/3). Linear mixed-effects models and extreme-gradient-boosting quantified associations and predictive performance. Results: Mean gestational TG rose from 138.6 ± 14.1 mg/dL to 166.9 ± 15.2 mg/dL, TyG by 0.21 ± 0.07 units and FMD fell by 1.86 ± 0.45%. MIRP-3 (“Metabolic + Inflammatory”; n = 31) showed the largest change (Δ) Δ-hsCRP (+0.69 mg/L) and Δ-FMD (–2.8%) and displayed a fetal IMT increase of +0.17 ± 0.05 mm versus +0.07 ± 0.03 mm in MIRP-1 (p < 0.001). Mixed-effects modelling identified Δ-TyG (β = +0.054 mm per unit), Δ-IL-6 (β = +0.009 mm) and Δ-FMD (β = –0.007 mm per %) as independent determinants of fetal IMT progression. An XGBoost model incorporating these Δ-variables predicted high fetal IMT (≥90th percentile) with AUROC 0.88, outperforming logistic regression (AUROC 0.74). Conclusions: A short-term surge in maternal TyG, IL-6 and endothelial dysfunction delineates a high-risk phenotype that doubles fetal aortic wall thickening and impairs myocardial performance. Composite dynamic indices demonstrated superior predictive value compared with individual lipid markers. Full article

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease often associated with metabolic disorders such as diabetes mellitus. Recent research suggests a link between systemic inflammation and insulin–glucose dysregulation in HS. This study investigates the relationship between insulin–glucose homeostasis, diabetes mellitus and the haptoglobin concentration in HS patients. Methods: We assessed 95 HS patients and 49 controls using validated fasting-based function tests, including the Structural Parameter Inference Approach (SPINA), Homeostasis Model Assessment (HOMA) and Quantitative Insulin Sensitivity Check Index (QUICKI). Results: The HS patients had a significantly higher fasting insulin concentration (97.2 vs. 69.0 pmol/L, p = 0.035), increased insulin resistance (HOMA-IR: 3.47 vs. 2.57, p = 0.016) and impaired insulin sensitivity (SPINA-GR: 1.34 vs. 1.76 mol/s, p = 0.017). In diabetes, the insulin sensitivity was more strongly reduced (SPINA-GR: 0.61 vs. 1.41 mol/s, p = 0.0057) and the insulin resistance increased (HOMA-IR: 7.3 vs. 3.2, p = 0.017). Higher haptoglobin concentrations were accompanied by worse glycaemic control, demonstrating a significantly elevated fasting glucose (5.77 vs. 5.11 mmol/L, p = 0.043) concentration and HbA1c (5.7% vs. 5.4%, p = 0.0081) fraction. Conclusions: Our findings suggest that chronic inflammation in HS contributes to metabolic dysregulation, worsening insulin resistance and glycaemic control, particularly in those with elevated haptoglobin or diabetes. Full article

Background and objectives: Type 2 diabetes mellitus (T2DM) affects brain white matter microstructure. While diffusion tensor imaging (DTI) has been used to study white matter abnormalities in T2DM, it lacks specificity for complex white matter tracts. Neurite orientation dispersion and density imaging (NODDI) offers a more specific approach to characterising white matter microstructures. This study aims to explore white matter alterations in T2DM using both DTI and NODDI and assess their association with disease duration and glycaemic control, as indicated by HbA1c levels. Methods and Materials: We analysed white matter microstructure in 48 tracts using data from the UK Biobank, involving 1023 T2DM participants (39% women, mean age 66) and 30,744 non-T2DM controls (53% women, mean age 64). Participants underwent 3.0T multiparametric brain imaging, including T1-weighted and diffusion imaging for DTI and NODDI. We performed region-of-interest analyses on fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), orientation dispersion index (ODI), intracellular volume fraction (ICVF), and isotropic water fraction (IsoVF) to assess white matter abnormalities. Results: We observed reduced FA and ICVF, and increased MD, AD, RD, ODI, and IsoVF in T2DM participants compared to controls (p < 0.05). These changes were associated with longer disease duration and higher HbA1c levels (0 < r ≤ 0.2, p < 0.05). NODDI identified microstructural changes in white matter that were proxies for reduced neurite density and disrupted fibre orientation, correlating with disease progression and poor glucose control. In conclusion, NODDI contributed to DTI in capturing white matter differences in participants with type 2 diabetes, suggesting the feasibility of NODDI in detecting white matter alterations in type 2 diabetes. Type 2 diabetes can cause white matter microstructural abnormalities that have associations with glucose control. Conclusions: The NODDI diffusion model allows the characterisation of white matter neuroaxonal pathology in type 2 diabetes, giving biophysical information for understanding the impact of type 2 diabetes on brain microstructure. Future research should focus on the longitudinal tracking of these microstructural changes to better understand their potential as early biomarkers for cognitive decline in T2DM. Full article

Carbohydrate intake (CI) has the largest impact on the short-term glycaemia of all nutrients, yet optimal CI management in gestational diabetes remains unclear. Objective: To examine CI behaviours in individuals with recently diagnosed gestational diabetes and their association with self-monitored blood glucose. Methods: Data from 97 individuals were collected using food and blood glucose diaries. CI (including amounts, types, and timing) was manually assessed using 15 g servings over 5–8 days, while a 3-day computerised analysis examined a broader intake of macro- and micronutrients. Results: Elevated fasting glycaemia (EFG) was associated with lower total CI (Mdn 10.8 vs. 12.5 servings/day, p = 0.006), missed meals (Mdn 1.4 vs. 0.0/week, p = 0.007), missed snacks (Mdn 10.5 vs. 7.5/week, p = 0.038), low-carbohydrate meals (<30 g; Mdn 4.3 vs. 2.0/week, p = 0.004), and a higher proportion of energy intake from fat (Mdn 35% vs. 33%, p = 0.047), as compared with in-target fasting glycaemia. In contrast, elevated postprandial glycaemia (EPG) was not significantly associated with total CI, low-carbohydrate meals (<30 g), low-carbohydrate snacks (<15 g), or high-carbohydrate loads (>50 g). EPG was instead associated with high-glycaemic index meals (Mdn 1.6 vs. 0.9 lunch meals/week, p = 0.026; Mdn 0.9 vs. 0.0 dinner meals/week, p = 0.023); and a lower intake of energy (Mdn 7650 kJ vs. 9070 kJ/day, p = 0.031), protein (Mdn 91 g vs. 109 g/day, p = 0.015), fat (Mdn 61 g vs. 84 g/day, p = 0.003), and multiple micronutrients (p <0.05), as compared with in-target postprandial glycaemia. Conclusions: CI profiles differed for individuals with EFG, as compared with EPG, emphasising the need for dietary guidelines tailored for gestational diabetes subtypes. Further interventional studies are needed to explore these findings, particularly the associations between EFG and low CI behaviours. Full article

Background: Type 2 Diabetes (T2D) is increasingly becoming a critical healthcare priority globally. Medical interventions are primary strategies for managing diabetes, but more recently, diet/nutrition therapy, including the use of functional food products such as cinnamon and/or cinnamon products, has garnered considerable attention. The focus of this systematic review and meta-analysis is to examine whether cinnamon improves blood glucose parameters, body mass index, and inflammatory markers in people with T2DM. Method: PRISMA and PICOS frameworks were used for the review. EBSCOhost was used to search for relevant literature in health science research databases, while EMBASE and reference lists were used to access other relevant articles. Results: For systematic review and meta-analysis, 14 and 12 studies, respectively, were included (five from Iran, two each from the USA and India, and one each from the UK, China, Germany, Portugal, and Iraq). All participants had T2DM with ages ranging from ≥30–65 years. The effect of cinnamon on glycaemic control and other parameters did not follow a regular pattern. Effect on HbA1c (nine studies and 605 participants; MD of −0.07 (95% CI, −0.13, −0.01, p = 0.02), postprandial blood glucose (PBG) and BMI showed significant (p < 0.05) reductions. However, cinnamon exhibited no significant (p > 0.05) impact on FBG (MD of −1.73 (95% CI, −3.98, 0.52, p = 0.13), CRP, TNF-α, and IL-6 in people with T2D; neither did the sensitivity test reveal any change in relation to these parameters. Conclusions: Cinnamon or cinnamon extracts/products are significantly effective in diabetes management through reduction in HbA1c, PBG, and BMI. Full article

Background and Objective: The aim of this study was to evaluate cardiorespiratory fitness (CRF) measures, maximal oxygen consumption (VO₂ max), and minute ventilation/carbon dioxide production (V_E/VCO₂ slope and others) among the T2DM population based on glycated haemoglobin (HBA1c). Material and Methods: The present study comprised a cross-sectional design, with two groups, based on HbA1c values (≤7 and ≥7.1). Laboratory samples were taken to evaluate glycated haemoglobin and fasting blood glucose (FBS). Cardiopulmonary exercise testing was performed to calculate various fitness-related parameters. Data analysis: An independent t-test was used to analyse the outcomes in the two groups. p < 0.05 was considered significant. Linear regression was used to examine the influence of predictor variables on dependent variables. Results: A total of 70 patients agreed to participate in the study, with 19 females and 51 males. The mean (standard deviation) BMI (body mass index) of all participants was 29.7(5.2), the mean (SD) weight was 84.4 (18.9) kg, and the mean height was 167.4 (23) cm. The average age of the individuals was 52 ± 8 years. The independent t-test revealed a significant difference between the two groups in terms of CRF measures. Conclusions: The current research identified the presence of poor glycaemic control and cardiorespiratory fitness measures among the Brazilian population with T2DM. HBA1c, duration of diabetes, age, and BMI can be employed to predict the ventilatory threshold (VT) and VO₂ max. Full article

Background/Objectives: Obesity and overweight have become increasingly prevalent in different populations of people with type 1 diabetes (PwT1D). This study aimed to assess the effect of body weight on glycaemic indices in PwT1D. Methods: Adult PwT1D using continuous glucose monitoring (CGM) and followed up at a regional academic diabetes centre were included. Body weight, body mass index (BMI), waist circumference, glycated haemoglobin (HbA1c), and standard CGM glycaemic indices were recorded. Glycaemic indices were compared according to BMI, and correlation and linear regression analysis were performed to estimate the association between measures of adiposity and glycaemic indices. Results: A total of 73 PwT1D were included (48% normal weight, 33% overweight, and 19% obese). HbA1c was 7.2% (5.6–10), glucose management indicator (GMI) 6.9% (5.7–8.9), coefficient of variation (CV) for glucose 39.5% ± 6.4, mean glucose 148 (101–235) mg/dL, TIR (time in range, glucose 70–180 mg/dL) 66% (25–94), TBR₇₀ (time below range, 54–69 mg/dL) 4% (0–16), TBR₅₄ (<54 mg/dL) 1% (0–11), TAR₁₈₀ (time above range, 181–250 mg/dL) 20% ± 7, and TAR₂₅₀ (>250 mg/dL) 6% (0–40). Glycaemic indices and achievement (%) of optimal glycaemic targets were similar between normal weight, overweight, and obese patients. BMI was associated negatively with GMI, mean glucose, TAR₁₈₀, and TAR₂₅₀ and positively with TIR; waist circumference was negatively associated with TAR₂₅₀. Conclusions: CGM-derived glycaemic indices were similar in overweight/obese and normal weight PwT1D. Body weight and BMI were positively associated with better glycaemic control. PwT1D should receive appropriate ongoing support to achieve optimal glycaemic targets whilst maintaining a healthy body weight. Full article

(1) Background: The Portfolio Diet, a dietary pattern of cholesterol-lowering foods, is also rich in low glycemic index (GI) foods. While strong evidence supports clinically meaningful reductions in cholesterol, evidence on the relationship between the Portfolio Diet and diabetes management is lacking. (2) Objective: To evaluate the relationship between the Portfolio Diet and glycated hemoglobin (HbA1c) as a determinant of glycemic control among adults living with type 2 diabetes mellitus (T2DM). (3) Methods: Patient-level data was pooled from two randomized dietary trials of low glycemic index interventions compared to high cereal fibre control diets in adults living with T2DM where HbA1c was collected (clinicaltrials.gov identifiers: NCT00438698, NCT00438698). Dietary exposure was assessed using weighed 7-day diet records. Adherence to the Portfolio Diet and its pillars (nuts and seeds, plant protein, viscous fibre, plant sterols, monounsaturated fatty acid [MUFA] oils) was determined using the validated clinical Portfolio Diet Score (c-PDS). Multiple linear regression was used to assess the association between change in the c-PDS and change in HbA1c over 6-months with covariate adjustments. (4) Results: A total of 267 participants, predominantly White (67%) and male (63%), were included, with a mean ± standard error age of 62 ± 0.5 years, baseline BMI of 30.2 ± 0.3 kg/m², HbA1c of 7.08 ± 0.03%, and a c-PDS of 4.1 ± 0.3 points out of 25. Change in the c-PDS was significantly associated with a change in HbA1c (β: −0.04% per point, 95% CI: −0.07, −0.02, p = 0.001). A 7.5-point (30%) increase in the c-PDS was associated with a 0.3% reduction in HbA1c. Of the individual pillars, a 1-point change in nut and seeds intake (β: −0.07%, 95% CI: −0.12, −0.02, p = 0.009) or in plant protein intake (β: −0.11%, 95% CI: −0.18, −0.03, p = 0.009) was associated with a change in HbA1c. Further analysis of plant protein intake revealed that an increase in dietary pulse intake, a particularly low-GI food, was significantly associated with a reduction in HbA1c (β: −0.24% per 1-cup points cooked pulses (226 g) or 2 c-PDS points, 95% CI: −0.45, −0.03, p = 0.028). (5) Conclusions: Among adults living with T2DM, the Portfolio Diet was associated with lower HbA1c over a 6-month period, predominantly driven by two pillars: nuts and seeds and plant protein, particularly dietary pulses. These data have implications for including the Portfolio Diet in dietary recommendations for glycemic control in T2DM. A trial demonstrating the direct causal effect of the Portfolio Diet in a diverse group is warranted. Full article