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Review

Culinary Medicine in Type II Diabetes Mellitus Management: A Narrative Review of Randomized Clinical Trials on Dietary Interventions (Nutritional Profiles of Meals and Snacks, Timing, Preparation and Key Considerations)

by
Maria Dimopoulou
1,
Odysseas Androutsos
2,
Michail Kipouros
2,
Alexandra Bargiota
3 and
Olga Gortzi
1,4,*
1
Department of Agriculture Crop Production and Rural Environment, School of Agriculture Sciences, University of Thessaly, 38446 Volos, Greece
2
Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition and Dietetics, University of Thessaly, 42132 Trikala, Greece
3
Department of Endocrinology and Metabolic Diseases, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, 41334 Larissa, Greece
4
POSS-Driving Innovation in Functional Foods PCC, Sarantaporou 17, 54640 Thessaloniki, Greece
*
Author to whom correspondence should be addressed.
Diabetology 2025, 6(8), 72; https://doi.org/10.3390/diabetology6080072 (registering DOI)
Submission received: 28 May 2025 / Revised: 2 July 2025 / Accepted: 21 July 2025 / Published: 31 July 2025
(This article belongs to the Special Issue Obesity and Diabetes: Healthy Lifestyle Choices)
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Abstract

According to the National Institutes of Health, approximately 465 million individuals are affected by type II diabetes mellitus (T2DM) and could benefit from managing their condition with a high-quality diet based on proper, nutrient-rich food choices. A plant-based diet not only has health benefits but also helps mitigate climate change by reducing greenhouse gas emissions, but the Mediterranean diet has the most beneficial effect on overall health. In contrast, ultra-processed foods have a negative impact on T2DM outcomes. Reviewing the nutritional profile of different meals, snacks and desserts would be helpful in enhancing their quality, strengthening the role of dietitians and doctors and protecting against T2DM complications. This approach would also increase simplification and education for consumers. The PubMed-Medline, Web of Science, Scopus and Cochrane Library databases were searched for relevant articles published up to May, from 2000 (based on publication date). The results support the need to reinforce health claims and highlight public demand for food choices while also improving patient quality of life.

1. Introduction

Type II diabetes mellitus (T2DM) develops due to a combination of insulin resistance and inadequate insulin secretion [1]. The pathogenesis is only partly understood, but it is heterogeneous, and both genetic factors that influence insulin release and sensitivity, as well as lifestyle and environmental factors such as obesity play an important role [2].
A total of 13.2% of all US adults had diabetes during 2017–2020 [2], and by 2050, more than 1 billion people are projected to have diabetes [3]. As for the parameters that play a crucial role in T2DM during childhood and adolescence, four important studies were conducted: GENESIS [4], ToyBox [5], Feel4Diabetes [6] and EMENO [7] studied the prevalence of T2DM and type I diabetes mellitus (T1DM) in adults in Greece. Irrespective of age, origin or educational background [8], a patient with T2DΜ is at an increased risk of complications due to metabolic disorders and interrelated risk factors [9,10,11,12,13,14,15,16,17]. The pathogenesis, including genetic susceptibility, environmental and occupational factors, tobacco use, high alcohol consumption, high body mass index (BMI), dietary factors and low physical activity, has been extensively studied [3].
Although educating diabetic patients is an essential part of diabetes management [1], self-monitoring is also of great benefit. In addition, dietary patterns have been analyzed worldwide to identify dietary strategies that could lead to improvement in postprandial glucose levels, glucose stability, and lipid biomarkers in patients with T2DM [18]. Undoubtedly, nutrition serves as an umbrella term [19], and foods should be analyzed not only for their nutritional profiles but also for the mechanisms by which their bioactive compounds achieve glucose stability, which is a comprehensive approach to T2DM nutritional management [20]. Furthermore, the use of medication could help achieve optimal glycemic control [21,22].
Culinary medicine is a lifestyle approach that links the functionality of foods [20] with the science of nutrition to promote health and prevent or manage diet-related diseases [23]. This approach may improve quality of life by helping patients make easier food choices [1] based on their preferences. However, meal testing to provide more diabetic-friendly food choices for patients is not a new concept due to the fact that medical nutrition therapy (MNT) has existed since 2022 [24].
Although many diet patterns have been proposed, a clear research question is if there is one that links nutrition, dietetics and functional foods for the treatment of the disease and prevention of its complications. The answer would have particular value because it could be a facilitator of patients’ choices while also improving their quality of life. This study will discuss the clinical profile, with a particular focus on glycemic markers, following the consumption of meals or snacks in adults with diabetes mellitus. It will evaluate their impact on T2DM outcomes based on nutritional profile, timing of consumption and preparation methods. To our knowledge, no other review has examined these parameters—such as nutritional profile, timing and preparation—alongside the effects of dietary interventions and meal alternatives on the biochemical markers of patients with T2DM. The findings of this study may provide an opportunity to reassess newer guidelines and other regulations concerning diabetic food products, strengthen health claims in various countries and address public demand for foods with health claims.

2. Methods

2.1. Review Aim and Strategy

This review was conducted following the Preferred Reporting items for Reviews (PRISMA) 2020 guidelines and checklist (Figure 1) [25]. This review aimed to explore if there is one that links nutrition, dietetics and functional foods for the treatment of the disease and prevention of its complications. The answer would have particular value because it could be a facilitator of patients’ choices while also improving their quality of life.

2.2. Literature Search, Study Selection, Eligibility Criteria and Quality Assessment

The search strategy involved a comprehensive examination of the following databases:
PubMed and Web of Science. Searches utilized MeSH terms and keywords, specifically targeting “#Type 2 diabetes mellitus,” “#Diet,” “#Interventions”, “#Snacks” “Meals,” “#Nutritional profile,” “#Nutrients,” “#Randomized clinical trial” and “#Bioactive compounds.” The aim was to investigate the relationship between the nutritional profile of different diet patterns, meals and snacks, with a particular focus on micronutrients, macronutrients and their impact on health.
Additional searches were conducted in PubMed, Web of Science, Scopus and the Cochrane Library using similar keywords, including “#Snacks,” “#Meals,” “#Bioactive compounds,” “#Health benefits,” “#Type 2 diabetes mellitus,” “#Hyperglycemia,” “#Obesity,” “#Nutrition,” “#Diet” and “#Randomized clinical trial.” Other terms such as “#Food” and “#Nutrition” were also included to ensure a broader scope. The objective was to explore dietary habits, nutritional interventions and the role of various bean types in modulating specific bioactive compounds and addressing related disorders.
The Scopus and Cochrane Library searches emphasized “#Diet,” “#Interventions,” “#Nutrition,” “#Type 2 diabetes mellitus,” “#Side effects” and “#Randomized clinical trial,” with the additional keyword “#Food.” The primary aim was to identify articles examining the association between food consumption and adverse symptoms, with particular attention given to the guidance provided by health professionals, since the rate of the problem has been confirmed [26]. The selection of these databases was based on their reputability, comprehensiveness and relevance to healthcare and medical research (Table 1). The inclusion and exclusion criteria are summarized in Table 2.

2.3. Outcome Measures

The primary outcome measure was the mean change in glycated hemoglobin (HbA1c) and fasting glucose between the intervention and comparator groups. Secondary outcome measures included the following:
1. Biochemical outcomes: Changes in lipid profile, post-prandial glucose, hormones etc.
2. Body anthropometry outcomes: Changes in body weight, body mass index (BMI) and body fat percentage.
Diabetology 06 00072 g001
Figure 1. Prisma flow chart of this study (version 2020) [27,28,29,30,31,32,33,34,35,36,37,38,39,40,41]. * PubMed 1203, Web of Science 4, Scopus 2000, Cochrane Library 51 ** Table 2.
Figure 1. Prisma flow chart of this study (version 2020) [27,28,29,30,31,32,33,34,35,36,37,38,39,40,41]. * PubMed 1203, Web of Science 4, Scopus 2000, Cochrane Library 51 ** Table 2.
Diabetology 06 00072 g001

3. Results

3.1. Dietary Interventions

This study examines the diet and eating habits of the patients. In this respect, the study differs from others that follow a similar pattern (Table 3) by emphasizing the role of food in function and examining the extent to which changes in human eating habits [19] can promote better nutrition, which is important for biomarkers relevant to T2DM. The Mediterranean diet is considered a healthy diet, and the extent to which changes in human eating habits at the end of the 20th century could be beneficial for T2DM patients has been investigated [26]. The prevalence of diabetes in Greece according the results of the First National Survey of Morbidity and Risk Factors (EMENO) study was 11.9% (95% CI: 10.9–12.9), known diabetes 10.4% (9.5–11.4) and undiagnosed diabetes 1.5% (1.1–1.9) [7].
The energy intake ranged from 1500 kcal per day to 1800 kcal per day [29]. The snack energy intake could range from 200–300 kcal [30], and ultra-processed food consumption was minimized [42]. Omega-3 fatty acids ranged from 56 mg/day to 98 mg/day [34,43]. No differences in the response to dietary interventions were observed across age, BMI and gender, but the duration from the T2DM diagnosis seemed to be a factor that could play a major role. Moreover, sustainability is a term that could and should be mentioned for the plant-based diets but also for interventions or diet patterns that are based on local and seasonal products.

3.2. Nutritional Profile

3.2.1. Snacks (Snack Bars, Homemade Cookies, Etc.)

Vegetables and fruits are an important part of a healthy eating pattern [29]. All snack bars share a common feature in their nutritional profile: a high amount of dietary fibers [44,45,46,47,48,49,50,51,52,53,54,55,56,57]. Although the consumption of snacks between the main meals is important in patient care [58], only a few clinical trials have investigated the acute metabolic effects of snacks in T2DM patients [44,45,51,52,59,60,61]. Although it would be beneficial to be rich in protein and low in saturated fats [62], the differences among meal choices lie not only in the percentage of protein content, which ranged from 2.5 g/100 g [45,50] to 21.95 g/100 g [51,63], but also in the carbohydrate content (1.3 g/100 g [52] −45.1 g/100 g) [46], and there is concern regarding the fact that snack bars can have 16.81 g/100 g [64] and muffins 17.3 g/100 g [49], which is a big snack. Side effects from snack bars such as bloating, nausea, etc., have been mentioned by participants [65]. Kouvari et al. highlights the need to avoid ultra-processed snacks [42]. Barnard et al. [39] calculated the nutrient contents such as vitamins and minerals from fruit and vegetable intakes for individuals completing the intervention, and vitamins K, C and B-6 were higher for the vegan group after the intervention, but adverse effects were observed for vitamin B-12, calcium and zinc.

3.2.2. Meals (Pies, Formulas, Etc.)

Almost all studies followed the recommendations of the American Diabetes Association (ADA) for the main meals, which usually included lean meat such as seafood and chicken or legumes with vegetables and whole grains in different portions in order to achieve the percentage of each pattern’s nutrient intake [27,28,29,30,31,32,33,34,35,36,37,38,40]. Kavanagh et al. proposed a diet pattern with <7% saturated fat and <200 mg of dietary cholesterol a day. Low-glycemic index foods are those that cause a slower, more gradual rise in blood sugar levels when eaten and are recommended [36]. Carbohydrates exhibit the highest concentration in liquid meal replacements [66], while dietary fiber is also present in significant amounts. The protein content ranges from 21 to 25 g per meal, whereas the fat content varies from 14.7 g [67] to 15 g. Greek vegetarian plates are notable for their low fat content [67].

3.3. Timing

Breakfast is often described as the most important meal of the day [68], and skipping this morning meal is really detrimental to health according to a recent study. Moreover, the results showed that participants on the later meal schedule woke up feeling hungrier, exhibited lower calorie expenditure and had adipose tissue changes indicative of increased fat storage. A previous study also found that eating four hours later significantly impacted hunger levels, postprandial energy metabolism and fat storage. Moreover, late-night eating has been linked to sleep disturbances and blood sugar spikes, making it advisable to avoid whenever possible [69].

3.4. Preparation

Plant-based chemicals that are not derived from animal sources and are known as phytochemicals act as antioxidants and anti-inflammatories, helping to reduce inflammation and counteract its harmful effects. In some cases, such as green leafy vegetables [70] and other vegetables [71], higher cooking temperatures can release more phytochemicals and enhance their antidiabetic properties [72,73]. Dried fruits aid digestion by providing fiber, which promotes intestinal health and prevents constipation. They are also rich in fiber, which aids digestion and promotes regular bowel movements [74]. Although the drying process slightly reduces some heat-sensitive micronutrients such as vitamin C, the majority of essential vitamins, nutrients and minerals are preserved [75]. For this reason, researchers have incorporated antioxidant-rich fruits and berries—such as raisins, dates [46] and dried cranberries—into snack bars and other functional snacks [54]. As a result, these foods offer additional benefits due to their anti-inflammatory plant phenols [50]. Similarly, leafy green vegetables have been added to anti-diabetic blended meals to increase their health benefits. As dried fruit is higher in calories and sugar than its fresh counterparts, portion sizes should be moderated [73]. In some cases, refrigerating or freezing toast or bread has a similar effect to heat treatment by reducing moisture and thus making the bread last longer, although the methods are different [73,76]. However, this process also lowers the glycemic index of the food, making it more suitable for T2DM patients [52,76,77] while contributing to lower body weight [77]. Nevertheless, this does not mean that bread should be completely eliminated from the diet [46,76,77]. It should be noted that processed products usually contain more sugar and calories [78]. Therefore, cooking at home is recommended to maintain nutritional quality and minimize nutrient losses [79]. In addition, preparing meals at home allows for better portion control, which helps to maintain an ideal body mass index (BMI) [78].

3.5. Missing Points

This review found that most studies focused on the use of low-glycemic ingredients such as natural sweeteners, fruits and nuts in the formulation of snacks but did not include an intervention with the daily consumption of these snacks to assess biomarkers relevant to T2DM management [45,46,47]. Exceptions are the studies by Mustad et al. (7-day–14-day intervention) [48] and Christiansen et al. (eight-week intervention periods) [50]. In addition, Nurdin et al. was the only study to investigate both the glycemic index of a snack bar in healthy adults [53] and its effects on biomarkers in patients with T2DM [44]. On the other hand, the potential of alternative protein sources, such as mushroom powder [65] or nuts [55,65], has not been extensively investigated [80]. According to the EFSA, it is crucial for T2DM patients to reduce total fat intake to <30% of daily energy expenditure, limit saturated fats (including trans fats) to <10%, increase fiber intake to at least 40 g/day [23] and increase ω-3 fatty acid intake [20]. Achieving these dietary goals consistently with conventional foods can be challenging over time [1]. The EFSA considers a daily intake of more than 25 g of dietary fiber to be sufficient to reduce diabetes-related complications such as coronary heart disease [81] and to improve weight maintenance, which is associated with better postprandial glucose regulation [82]. With regard to the total fat content, the results are inconclusive and further research is needed, particularly in relation to legal guidelines for fat utilization [23]. The authors should critically re-evaluate the results of the diet interventions and consider the extent to which these results are consistent with their working hypotheses and whether they could be of benefit to a wider population (Table 4) with less restrictive inclusion criteria as part of a daily dietary plan. Future research directions should also investigate the applicability of these results to different types of diabetes mellitus.
Diabetes is a cardiometabolic disorder in which both microvascular and macrovascular complications contribute to morbidity and mortality [83]. Figure 2 shows how nutritional interventions can minimize these complications with certain impacts on biomarkers.

4. Discussion

The rapid evolution of human societies has led to an increased incidence of metabolic disorders. This recent scientific research (from 2000 to 2025) on nutritional therapy for adults with T2DM [83] links nutrition, dietetics and functional foods for the treatment of the disease and prevention of its complications [18]. It has particular value because it could be a facilitator of patients’ choices while also improving their quality of life. Medical nutrition therapy (MNT) is a key component of diabetes education and management [84].
When it comes to weight control, there is no one size fits all. There is no ideal macronutrient ratio for weight loss, but hypocaloric diets with different macronutrient compositions can be effective as long as they are consistent with dietary recommendations. Replacing one or two meals per day with formulated meal replacements is acceptable. Individuals who are overweight or obese may even achieve remission of T2DM without having to take antidiabetic drugs, provided they have lost sufficient weight [85]—approximately 0.5–9.8 kg (Table 4) [29,30,31,32,33,34,35,36,37,38,39,40,41]. The clinical evidence from this study supports this: the Diabetes Excess Weight Loss study showed no reversal of diabetes in 2 years [38] with a ketogenic diet, while the control group lost weight (2–3 kg, p < 0.001) and reduced their waist circumference (2–3 cm, p < 0.001). In the DIRECT study [29], a low-carbohydrate diet was found to be more effective than a low-fat diet for weight loss and improving HDL and triglycerides. Intermittent fasting studies [37] show an improvement in HbA1c levels even without weight loss. A Mediterranean diet with higher fat and lower carbohydrate intakes leads to lower mortality [30], and biomarkers such as HbA1c and LDL cholesterol are minimized and HDL cholesterol is increased [27,28,29,30,39]. HbA1c, two-hour second glucose and serum alanine aminotransferase (ALT) were lower in most studies with low carbohydrate intake [29,33], and it would be helpful to count baseline carbohydrates [86]. The studies in this review were based on guidelines such as whole grains, low-fat dairy products, high-fructose fruit smoothies and six small meals per day. Meanwhile, people are reversing their insulin resistance and improving their lipid levels with low-carb, ketogenic and carnivorous diets; time-restricted eating or intermittent fasting; strategic supplementation; and lifestyle changes before taking medications. On the other hand, many professional organizations—the ADA [87] and the American Heart Association (AHA) [88]—still adhere to old, industry-supported advice, which may be because eating packaged cereals, seed oils and snacks is not only convenient but also more acceptable to patients with T2DM than promoting protein, unsaturated fatty acids and metabolic flexibility. According to the results of this review, patients should shed their fear of saturated fat and become more sensitive to carbohydrate consumption to avoid the consequences of chronic hyperinsulinemia and metabolic dysfunction. Clinicians, dietitians and caregivers have already found that patients who try non-processed foods, strategic restriction and nutrient support have better glycemic biomarker outcomes than patients who stick to the standard script.
Individual foods are part of a diet characterized by their nutrient content, food groups and times of consumption [19]. According to the studies included in this review (Figure 1 and Table 1 and Table 2), most of them introduce an individualized dietary approach that emphasizes carbohydrate restriction over fat restriction, the substitution of SFAs with MUFAs and PUFAs and adequate intake of dietary fiber, all of which are key factors for optimizing diabetes management (Table 3) [89]. Previous interventions have suggested the adoption of the DASH diet not just for diabetic patients as a behavioral intervention for weight loss [90] nor simply as an ideal dietary pattern for T2DM patients, but rather, for hypertension management [91]. Vegan and Mediterranean dietary patterns may be effective in improving glycemic control in T2DM patients, and intermittent fasting, although promising, requires further investigation [92]. Another important finding highlighted in this review is the concern for nutrient intake [93]. Thus, it is not only the dietary pattern that matters but also the amount of consumption of each food [94], as well as other factors [95,96,97] that should be considered to achieve a healthy body weight and a high-quality diet [94,98] from childhood to prevent T2DM later in life. At a younger age, it can be difficult to prevent unhealthy eating habits as children often follow their parents’ dietary patterns [99,100]. Our findings demonstrate that lifestyle modifications, including physical activity combined with diet and nutrition, can lead to significant anthropometric changes that result in improvements in abdominal adiposity, as measured by waist circumference (WC), and in certain inflammatory markers in overweight/obese individuals with T2DM [92] and other biomarkers. However, further high-quality research is needed to clarify the underlying mechanisms by which these interventions affect inflammatory markers in this population [101].
Not only the nutrient profile of diets but also the ingredients of many foods are responsible for the acute effects on postprandial glucose and insulin levels. Many of these ingredients, such as mushrooms, fruits (e.g., cranberries, grapes) and vegetables, have been labeled “functional foods,” and their mechanisms of action have been extensively studied [72].
Functional foods are divided into the following categories based on their effects: (1) those that contain an increased concentration of a beneficial ingredient, such as phytosterols or dietary fiber; (2) those that contain an additional beneficial ingredient, such as vitamins, minerals or probiotic cultures; (3) those that help eliminate negative ingredients, such as allergens; and (4) those in which a negative ingredient has been partially replaced by a positive one, such as fat substitutes [102]. Several brands have attempted to improve their health claims by, for example, offering a portion of daily fiber or fruit intake per bar or containing less than 100 calories [65]. However, few have conducted clinical trials in patients with type 2 diabetes mellitus [103]. Studies suggest that 40–48% of patients aged 40–70 years consume foods designed for diabetics to reduce the complications associated with the disease (Figure 2) [72].
In the early 1980s, the UK was one of the first countries to establish new criteria for “diabetic foods,” clarifying that for a product to be labeled as “suitable for diabetics,” it must not contain more fat or energy than its conventional counterpart. Today, according to the EFSA, a food is considered suitable for diabetics if it has a low glycemic load (compared to 50 g of anhydrous glucose) and if its daily consumption over a period of at least three months leads to a positive change in the HbA1c value. Special foods for diabetics are often more expensive than conventional low-sugar products. The sweeteners used in these products are generally considered safe if they are consumed within the recommended daily intake. These include both natural sugar substitutes (xylitol, mannitol, isomalt and maltitol) and artificial sweeteners (saccharin, aspartame, sucralose, acesulfame K and cyclamate), which are regulated by the EFSA [104]. The following are dietary recommendations for diabetes management:
-
Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes (EASD). European recommendations for the dietary management of diabetes (2023): “Intake of free or added sugars should be less than 10% of total energy intake. Non-nutritive sweeteners can be used to replace sugar in foods and beverages” [87,105].
-
Medical Nutrition Therapy Recommendations (2023): “The use of non-nutritive sweeteners to replace sugar-sweetened products may reduce total calorie and carbohydrate intake as long as there is not a compensatory increase in energy intake from other sources. There is evidence that low- and no calorie sweetened beverages are a viable alternative to water” [105].
-
Diabetes UK Evidenced-based Nutrition Guidelines for the Prevention and Management of Diabetes (2019): “Non-nutritive sweeteners are safe and can be recommended” [106,107].
Even in the early stages of the disease, patients with T2DM have an increased risk of complications, with cardiovascular (CV) and renal impairment often being among the earliest cardio–renal manifestations. Cardiovascular and renal disease are major contributors to increased mortality in patients with T2DM [9,10,11,12,13,14,15,16,17]. The treatment of T2DM requires a timely, patient-centered, integrated and multifaceted approach that not only improves glycemic control and other risk factors but also reduces the risk of complications such as cardiovascular and renal disease [24]. The scientific evidence on fats and weight management focuses on the following points:
  • Calorie intake: Many low-fat products contain added sugars to enhance flavor, which can lead to increased calorie consumption and, over time, weight gain.
  • Satiety: Healthy fats (such as those found in avocados, nuts and olive oil) play a crucial role in reducing hunger pangs and making meals more filling. Without these fats, people can eat too many carbohydrates and proteins.
  • Hormonal balance: Dietary fats support hormone production, including leptin, a hormone that regulates appetite and fat storage. A very-low-fat diet can disrupt this balance.
  • Insulin sensitivity: When fats are replaced by refined carbohydrates, this can lead to blood sugar spikes and crashes, which promote fat storage rather than fat loss [108].
This review highlights the relationship between meal planning, the nutrient profile of the overall diet and glycemic parameters in adults with type 2 diabetes. This relationship is consistent with dietary goals, which include the following:
Maintain glycemic control, including insulin therapy if necessary, in accordance with the individualized nutrition plan and physical activity model.
-
Achieve blood pressure and lipid profile targets.
-
Ensure adequate energy intake to support healthy weight and metabolic function.
-
Treatment of comorbidities such as arterial hypertension, hyperlipidemia, chronic kidney disease, cardiovascular disease and screening for celiac disease.
-
Prevention of diabetes complications, both immediate (hyper- and hypoglycemia) and long-term (micro- and macrovascular epilogs).
-
Promoting general health through balanced and nutritious food choices.
-
Meeting individual nutritional needs, taking into account personal and cultural preferences, encouraging willingness to change and maintaining enjoyment of food without unnecessary restrictions [85].
Another important finding is the frequency of meal consumption. According to Papakonstantinou et al., it is more beneficial to eat smaller and more frequent meals [109]. Another important finding is that home-cooked meals have a positive effect on postprandial blood glucose levels [63] and may be a sustainable strategy with cost benefits. Finally, convenience foods could be a good choice for people with limited free time, even for T2DM patients, if they are prepared with healthy ingredients [67]. Snacks could also be a convenient option [61], provided they have the right nutritional composition, including carbohydrates and fiber [65]. Timing may also play a crucial role, as eating snacks in the morning may minimize the impact on blood glucose levels [69]. However, eating a traditional breakfast has been shown to impair glucose response [49]. Last but not least, freezing or refrigerating foods such as bread or rice can lower their glycemic index by altering the starch structure [73,76].
Future studies should include a larger number of participants. Conducting such studies with a larger population size would provide more information on the changes in health biomarkers associated with the consumption of these functional foods. The use of functional foods and branded foods with solid scientific evidence of efficacy could help reduce the incidence of diseases such as diabetes and dyslipidemia. This emphasizes the need for a well-designed diet consisting primarily of whole grains, fruits, vegetables and healthy fats, with the controlled addition of functional foods. Considering the principles of personalized nutrition for disease prevention, another crucial aspect to consider is that the effect of a food ingredient may vary from person to person. The future of metabolic care depends on a holistic approach where dietary carbohydrate restriction and ongoing remote support can safely help adults with T2DM to reduce HbA1c, weight and medication use [110,111,112,113,114].

5. Conclusions

In conclusion, the nutritional profile of most of the meals examined in this study is well in line with current recommendations for T2DM management. However, the American Diabetes Association’s Standards of Care 2025 states, “Data do not support a specific macronutrient pattern, and consideration is given to reducing total carbohydrate intake in adults with diabetes to improve blood glucose levels.” Healthy fats should be prioritized, including sources such as nuts, seeds, avocados and oily fish. The focus should be on eating unsaturated fats from sources such as nuts, seeds, avocados and oily fish, while processed foods and hidden sugars should be limited. Furthermore, the results suggest that the timing and frequency of meals are crucial for optimizing glucose metabolism. Eating larger meals early in the day may improve glycemic response, while frequent, smaller meals may further stabilize postprandial blood glucose levels. Preparing meals at home has been identified as a beneficial strategy to improve diet quality and glycemic outcomes, while premade meals and snacks, when composed of nutritious ingredients, may provide a convenient alternative for individuals with limited time. By reinforcing these dietary principles and prioritizing high-quality, nutrient-dense foods, people with T2DM can improve their metabolic health.

Author Contributions

Conceptualization, O.A., A.B., O.G., and M.D.; methodology, A.B., O.A., O.G., and M.D.; software, M.D.; validation, O.A., A.B., M.D., and M.K.; formal analysis, M.D.; investigation, O.A., M.D., and M.K.; resources, O.A., M.D., and M.K.; data curation, M.D.; writing—original draft preparation, M.D.; writing—review and editing, O.A., M.D., and M.K.; visualization, A.B., O.G., and O.A.; supervision, O.G., O.A., and A.B. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Data Availability Statement

No new data were created.

Conflicts of Interest

The authors declare no conflicts of interest. Author Olga Gortzi was employed by the company POSS—Driving Innovation in Functional Foods PCC. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Figure 2. The dietary interventions’ impact on biomarkers for patients with T2DM [27,28,29,30,31,32,33,34,35,36,37,38,39,40,41].
Figure 2. The dietary interventions’ impact on biomarkers for patients with T2DM [27,28,29,30,31,32,33,34,35,36,37,38,39,40,41].
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Table 1. Details regarding the search process and unique contributions of each database to this study.
Table 1. Details regarding the search process and unique contributions of each database to this study.
DatabaseKeywordsMeSH Terms (PubMed)Initial ArticlesDuplicates RemovedFinal Articles for AnalysisContribution to StudyReason for Inclusion
PubMed#Meals, #Snacks, #Diet, #Nutritional profile, #Nutrients, #Bioactive compounds, #Health benefits, #Cardiovascular disease, #Type 2 diabetes mellitus, #Obesity, #Nutrition, #Diet and #Randomized clinical trial#Diet, #Interventions, #Type 2 diabetes mellitus, #Nutrients, #Nutrition 12031891014Provided a broad understanding of the interplay between diet, food consumption, dietary interventions and health benefits; MeSH terms ensured precision in the search for relevant literatureWidely recognized as a premier biomedical database, frequently used for reviews in healthcare research
Web of Science#Meals, #Snacks, #Snack-bars, #Desserts, #Diet, #Nutritional profile, #Nutrients, #Bioactive compounds, #Health benefits, #Diabetes mellitus, #Hyperglycemia, #Hypoglycemia, #Obesity, #Nutrition, and #Diet, #Randomized clinical trialN/A (Web of Science does not use MeSH terms)422Enhanced the overall coverage of the literature related to the nutrients in meals and snacks, dietary interventions and their impact on healthProvides a multidisciplinary approach, covering a wide range of scientific disciplines
Scopus#Meals, #Snacks, #Diet, #Interventions, #Nutrition, #Type 2 diabetes mellitus, #Side effects and #Randomized clinical trial#Diet, #Interventions, #Type 2 diabetes mellitus200020000Strengthened the evidence base by focusing on bioactive compounds in meals and snacks related to evidence-based interventions; MeSH terms ensured specificity in selecting relevant literatureRenowned for reviews and emphasizing evidence-based interventions in healthcare research
Cochrane Library#Interventions, #Diet, #Nutrition, #Type 2 diabetes mellitus, #Side effects and #Randomized clinical trial#Diet, #Interventions, #Nutrition, #Type 2 diabetes mellitus, #Side effects, #Randomized clinical trial51492Strengthened the evidence base by focusing on bioactive compounds in meals and snacks related to evidence-based interventions; MeSH terms ensured specificity in selecting relevant literatureRenowned for reviews and emphasizing evidence-based interventions in healthcare research
Table 2. Inclusion and exclusion criteria.
Table 2. Inclusion and exclusion criteria.
Inclusion CriteriaExclusion Criteria
Published in English Non-original research
Randomized controlled trials Not a human study
Participants aged >18 years oldNo comparator group
Patients with type 2 diabetes mellitus (T2DM)
Studies with a minimum 12-month follow-up and a minimum of 50 completorsCohort study
Studies published before 2000
Table 3. Dietary interventions for T2DM are crucial for managing the disease.
Table 3. Dietary interventions for T2DM are crucial for managing the disease.
Study/AuthorsMethodologyParticipantsAge GroupDiet Pattern 1Results 2References
Hernáez et al., 2017Randomized controlled trial
(1 year)		196 participants, with half of them being patients with T2DM (113 females and 83 males)55–80 years oldTwo variations of the Mediterranean diet, one enriched with virgin olive oil and the other enriched with nutsThe Mediterranean diet, especially when enriched with virgin olive oil, improved the atheroprotective functions of HDL in individuals at high cardiovascular risk.[27]
Maiorino et al., 2016Randomized clinical trial (8.1 years)215 patients with T2DM (106 males and 109 females)52.4 ± 11.2 years oldThe Mediterranean diet aimed to provide no more than 50% of daily energy from carbohydrates and at least 30% of energy from fat; the low-fat diet aimed to provide no more than 30% of energy from fatDiabetic patients with the highest scores (6–9 points) of adherence to the Mediterranean diet had lower circulating CRP levels and higher circulating total adiponectin levels compared to diabetic patients who scored <3 points on the scale.[28]
Shai et al., 2008Randomized clinical trial (2 years)322 with body-mass index of at least 27 or the presence of T2DM or coronary heart disease40–65 years oldLow-CH, Mediterranean or low-fat dietAmong the participants with diabetes, the proportion of glycated hemoglobin at 24 months decreased by 0.4 ± 1.3% in the low-fat group, 0.5 ± 1.1% in the Mediterranean-diet group and 0.9 ± 0.8% in the low-carbohydrate group. The changes were significant only in the low-carbohydrate group.[29]
Kouvari et al., 2024Cohort multiple randomized clinical trial (20 years)103 patients with T2DM (45 females and (58 males)41 ± 12 years oldMediterranean dietReduction in all-cause mortality of 9.5%.[30]
Bhanpuri et al., 2018Randomized clinical trial 1 year)262 patients with T2DM (87 females and 175 males)54 ± 8 years oldLow-CH diets and very-low-CH (ketogenic) diets: <50% kcal/d from CH and <10% kcal/d from CH in ketogenic diets
High protein intake (20–30% kcal/d)
High fat intake (30–70% kcal/d)		Weight-loss and weight-loss maintenance.
Reduction in DBP.
Reduction in LDL-c and triglyceride levels.
Increase in HDL-c levels.		[31]
Tay et al., 2015Randomized clinical trial (1 year and 1 month)115 obese with T2DM (66 males and 49 females)35–68 years oldLow-CH diets and very-low-CH (ketogenic) diets: 53% kcal/d from CH and 17% from protein and <10% kcal/d from CH in ketogenic diets High protein intake (28% kcal/d)
High fat intake (58% kcal/d)		Improvements in insulin resistance.
Reduction in HbA1c levels.		[32]
Chen et al., 2022Randomized controlled trial (1.5 year)71 patients with T2DM (48 males and 23 females)63.2 years oldLow-CH diet: 90 g/dayBetter outcome on glycemic
control, liver function and medication effect score.		[33]
Lasa et al., 2014Randomized clinical trial (1 year)191 participants with T2DM (77 men and 114 women)55–64.8 years oldLow-fat diet: <30% kcal/d from total fat (<10% saturated fat) 15–17% kcal/d from protein 50–60% kcal/d from CHImproved glucose metabolism and a short-term improvement in the cholesterol profile.
Short-term weight loss.		[34]
Esposito et al., 2009Randomized clinical trial (4 years)215 patients with T2DM52.4 years oldMediterranean diet
versus low-fat diet		Greater reduction in HbA1c and fasting plasma
glucose in the Mediterranean diet group.
Increase in adiponectin concentrations and
improvement in HOMA.		[35]
Kavanagh et al., 2024 Randomized clinical trial (3 years)267 patients with T2DM (98 females and 169 males)62 ± 0.5 years oldThe Portfolio Diet, comprising low-glycemic index or a high-cereal fiber dietReduction in HbA1c.[36]
Carter et al., 2018Randomized clinical trial (1 year)137 patients with T2DM (77 females and 60 males)61 years oldIntermittent fasting (5:2): (500–600 kcal/d) followed for 2 nonconsecutive days per week (participants followed their usual diet for the other 5 days) or a continuous energy restriction diet (1200–1500 kcal/d) followed for 7 days per week for 12 monthsReduction in HbA1c.[37]
Krebs et al., 2012Randomized controlled trial (2 years)416 patients with T2DM
(168 males and 248 females)		30–75 years oldHigh-protein diet:
High protein intake (20–30% kcal/d) or 1.34–1.50 g/Kg of protein per kilogram of body weight per day
Low CH intake (40–50% kcal/d)		Reductions in triglyceride levels, body weight, waist circumference, body fatness, HbA1c and blood pressure along with improvements in renal function were observed.[38]
Barnard et al., 2009Randomized controlled trial (1.5 year)99 patients with T2DM (39 males and 60 females)56.7–69.8 years oldA low-fat vegan dietReductions in body weight, total cholesterol and LDL.[39]
Yaikwawong et al., 2024Randomized controlled trial (1 year)229 patients with T2DM (116 males and 153 females)≥35 years oldCurcumin (1500 mg/day) or placebo Curcumin extract improves beta cell functions in obese patients with type T2DM.[40]
Lean et al., 2024Randomized Diabetes Remission
Clinical Trial (DiRECT) (5 years)		149 participants with T2DM 20–65 years oldTotal diet replacement (825–853 kcal per day formula diet) combined with physical activity and support for weight-loss maintenanceMean weight loss of 7–6 kg with 36% of participants in remission of type 2 diabetes.[41]
1 Monounsaturated fatty acids, MUFAs; extra virgin olive oil, EVOO; carbohydrate, CH. 2 Cardiovascular disease, CVD; blood pressure, BP; type 2 diabetes mellitus, T2DM; unsaturated fatty acids, UFAs; body mass index, BMI; diastolic blood pressure, DBP; low-density lipoprotein cholesterol, LDL-c; high-density lipoprotein cholesterol, HDL-c; glycated hemoglobin, HbA1c; free fatty acids, FFAs.
Table 4. The changes in biomarkers found in studies included in this research that are associated with increased T2DM consequences.
Table 4. The changes in biomarkers found in studies included in this research that are associated with increased T2DM consequences.
Biochemical Biomarkers ***Mean Changes After the Diet Interventions of 15 Included Studies Compared with the Control Ones 1p-Value *References
Decreased values of glycated hemoglobin (HbA1c) (%)0.16–1.1%p < 0.01[28,29,32,34,38]
Decreased values of fasting plasma glucose (mg/dL)0.7–5.2p < 0.01[32,41]
Decreased values of insulin (pmol/L)38%p < 0.01[32]
Decreased values of HOMA-IR64%p < 0.01[27,32,35]
Decreased values of total cholesterol (mg/dL)0.1 (19%)p < 0.01[36,38]
Decreased values of LDL-C (mg/dL)0.2–2.72 (4.9%)p < 0.01[32,38]
Increased values of HDL-C (mg/dL)0.1p < 0.01[27,30,35,38]
Increased values of Total/HDL-cholesterol ratio19–29.1%p < 0.01[35,39]
Increased values of HDL-C levels (mg/dL)1.3p < 0.01[27,30]
Decreased values of body weight (kg)0.5−9.8p < 0.01[32,34,39,41]
Decreased values of systolic blood pressure (mmHg)1–7.3p < 0.01[27,32,39]
Decreased values of diastolic blood pressure (mmHg)1–8.6p < 0.01[27,32,39]
Decreased values of waist circumference (cm)4p < 0.01[34,38]
Decreased values of HOMA-IR64%p < 0.01[30,35,39]
Minimization of additive risk factors for atherosclerotic cardiovascular disease (ASCVD)−11.9%p < 0.01[27,30]
Increased values of ApoA-I (mg/dL)3 (+9.8%)p < 0.01[27]
Decreased values of Apo B (mg/dL)5 (−1.6%)p < 0.01[27]
Decreased values of ApoB/ApoA-I ratio−9.5%p < 0.01[29]
Decreased values of CRP (mg/L)0.3–1.3 (53%)p < 0.01[28,32]
Increased values of adiponectin (μg/mL)0.2–0.8 (72%)p < 0.01[28,34,35]
Increased values of adiponectin/leptin ratio0.043p < 0.01[34]
Increased values of adiponectin/HOMA-IR ratio0.06p < 0.01[34,35]
*** HbA1c: glycated hemoglobin, LDL-c: low-density lipoprotein, HDL-c: high-density lipoprotein cholesterol, HOMA-IR: the homeostasis model assessment of insulin resistance, FPG: fasting plasma glucose, BP: blood pressure, BW: body weight, Apo A-I: indicates Apo lipoprotein A-I, Apo B: Apo lipoprotein B, CRP: C-reactive protein. 1 Intervention duration is an important attribute in program evaluation, and the long-term interventions had more beneficial results as a therapeutic approach. Better results were achieved when the participants combined the diet intervention with physical activity. Data are the means ± standard deviation (SD) or median value (interquartile range). * p values for the comparison with baseline by Wilcoxon paired t-test.
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Dimopoulou, M.; Androutsos, O.; Kipouros, M.; Bargiota, A.; Gortzi, O. Culinary Medicine in Type II Diabetes Mellitus Management: A Narrative Review of Randomized Clinical Trials on Dietary Interventions (Nutritional Profiles of Meals and Snacks, Timing, Preparation and Key Considerations). Diabetology 2025, 6, 72. https://doi.org/10.3390/diabetology6080072

AMA Style

Dimopoulou M, Androutsos O, Kipouros M, Bargiota A, Gortzi O. Culinary Medicine in Type II Diabetes Mellitus Management: A Narrative Review of Randomized Clinical Trials on Dietary Interventions (Nutritional Profiles of Meals and Snacks, Timing, Preparation and Key Considerations). Diabetology. 2025; 6(8):72. https://doi.org/10.3390/diabetology6080072

Chicago/Turabian Style

Dimopoulou, Maria, Odysseas Androutsos, Michail Kipouros, Alexandra Bargiota, and Olga Gortzi. 2025. "Culinary Medicine in Type II Diabetes Mellitus Management: A Narrative Review of Randomized Clinical Trials on Dietary Interventions (Nutritional Profiles of Meals and Snacks, Timing, Preparation and Key Considerations)" Diabetology 6, no. 8: 72. https://doi.org/10.3390/diabetology6080072

APA Style

Dimopoulou, M., Androutsos, O., Kipouros, M., Bargiota, A., & Gortzi, O. (2025). Culinary Medicine in Type II Diabetes Mellitus Management: A Narrative Review of Randomized Clinical Trials on Dietary Interventions (Nutritional Profiles of Meals and Snacks, Timing, Preparation and Key Considerations). Diabetology, 6(8), 72. https://doi.org/10.3390/diabetology6080072

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