An Italian study of people with type 2 diabetes has found that 70 percent of those who followed a low-fat diet eventually needed diabetes drugs, as opposed to only 44 percent of those who ate a Mediterranean diet.

The Mediterranean diet is high in fruits, nuts, legumes, cereals, and fish. Olive oil is its primary source of monounsaturated fat. A low to moderate intake of wine is another feature, along with a low consumption of red meat and poultry.

According to study author Dr. Dario Giugliano, a professor of endocrinology and metabolic diseases at the Second University of Naples in Italy, the diet also conferred other benefits, including weight loss and a reduction in cardiovascular risk factors.

Dr. Giugliano's study compared 107 people on a low-fat diet to 108 on a Mediterranean diet over a four-year period. At the study's start, all 215 participants had been recently diagnosed with type 2 diabetes. By the end of the study, the number of people who required diabetes medications was 26 percent less in the Mediterranean group than in the low-fat group.  Consumption of the Mediterranean diet reduced the need for medication by 37 percent.

The body mass index for the Mediterranean diet group also dropped 1.2 points over the course of the study, compared to 0.9 points for the low-fat diet group. In addition, blood pressure and cholesterol were lower for the Mediterranean group than for the low-fat group. In light of these findings, the Mediterranean diet may also be good news for people with metabolic syndrome, the cluster of symptoms that often precede the development of type 2 diabetes. Those symptoms include high blood pressure, high cholesterol, and high body mass index, in addition to high blood sugar.

Still, Dr. Giugliano's findings add even more complexity to the issue of what diet is "best" for people with type 2 diabetes. For years, the American Diabetes Association recommended a low-fat diet because fat intake is associated with high cholesterol and the threat of atherosclerosis and cardiovascular disease. The low-fat diet was also assumed to help control weight.  According to critics, however, low-fat diets are problematic because they require a higher intake of carbohydrates to provide calories and nutrients-not a good idea, they say, when dealing with a disease for which carbohydrate consumption poses a major risk.

In 2008, the ADA revised its stand and recommended low-carb diets as an alternative way for people to lose weight and control blood sugar. The association's new recommendation was based on mounting evidence that a low-carbohydrate diet seems to work extremely well for some type 2 patients. The association and other diabetes groups continue to advise those with type 2 to set up individualized diet plans with certified dietitians, however, because the best diets incorporate foods that people like and take into account their unique metabolic reactions to particular foods.