Clinical Nutrition Open Science · Published 2026-04-04 · DOI 10.1016/j.nutos.2026.100657
Background: The rising prevalence of type 2 diabetes mellitus (T2DM) in the Middle East and North Africa requires cultural appropriate dietary strategies. Traditional Iraqi cuisine encompasses naturally gluten-free foods (rice, legumes and vegetables) with favorable glycemic profiles. Gluten-free dietary patterns that are high in fiber and low glycemic load may lead to improved metabolic control through microbiome modulation, reduced intestinal permeability and anti-inflammatory effects, although evidence from resource-limited settings remains limited. Objective: To evaluate the effectiveness of a culturally adapted gluten-free dietary intervention versus standard nutritional counseling on glycemic outcomes in newly diagnosed T2DM patients in Baghdad. Methods: A prospective single-blinded randomized controlled trial was conducted at the National Diabetes Centre, Baghdad (January–August 2023). A total of 172 adults with newly diagnosed T2DM were randomized (1:1) to a culturally adapted gluten-free diet or standard dietary counseling for 12 weeks. The intervention emphasized traditional naturally gluten-free foods providing a high-fiber, low-glycemic dietary pattern. Adherence was assessed using bi-weekly food diaries and 24-h dietary recalls. Laboratory staff and outcome assessors were blinded. Primary outcomes were fasting glucose, HbA1c, and postprandial glucose. Analysis was performed using intention-to-treat with Bonferroni adjustment. Results: Both groups showed significant within-group improvements (P<0.001). Gluten-free group demonstrated greater reductions in fasting glucose (−42.7 vs. −31.2 mg/dL; P=0.003) and HbA1c (−1.48% vs. −1.21%; P=0.012). Participants ≥50 years exhibited the greatest benefit (−48.2 vs. −29.4 mg/dL; P=0.001). HbA1c <7% was achieved 67.4% in intervention group compared with 51.2% of controls (P=0.032). Baseline demographic and clinical characteristics were comparable between groups. Conclusion: A culturally adapted gluten-free dietary pattern based on traditional high-fiber, low-glycemic foods significantly improved glycemic control in newly diagnosed T2DM patients. Benefits likely reflect combined effects of gluten avoidance, increased fiber intake, and reduced refined carbohydrates. Larger multicenter studies with longer follow-up are required to confirm the durability and generalizability of these findings.
Abstract from DOAJ. Public domain (CC0 1.0).
Read the article at the publisher →