Association of Dietary Patterns With Glycemic Control in Patients With Type 2 Diabetes in Gilgit-Baltistan and Azad Kashmir

Abstract

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a rapidly increasing public health concern in Pakistan, where dietary habits vary widely across regions. Understanding how local dietary patterns influence glycemic control is essential for developing culturally tailored nutritional interventions. Despite extensive global research, data from Northern Pakistan particularly Gilgit-Baltistan and Azad Kashmir remain scarce.

OBJECTIVE: To examine the association between dietary patterns and glycemic control among adults with T2DM in Gilgit-Baltistan and Azad Kashmir.

METHODOLOGY: A cross-sectional study was conducted among 418 adults with T2DM attending private healthcare facilities. Dietary intake was assessed using a culturally adapted, semi-quantitative food frequency questionnaire. Principal component analysis identified major dietary patterns. Glycemic control was evaluated using glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG). Associations between dietary patterns and glycemic outcomes were analyzed using multivariable linear regression, adjusting for potential confounders including age, sex, BMI, diabetes duration, and medication use.

RESULTS: Three main dietary patterns emerged: (1) Traditional-whole foods (rich in whole grains, legumes, fruits, and vegetables), (2) Refined and processed (high in refined carbohydrates, sugary beverages, and processed meats), and (3) Mixed-animal heavy. Participants in the highest tertile of the Traditional-whole foods pattern had lower mean HbA1c (7.7 ± 1.3 %) and FPG (149 ± 29 mg/dL) compared to those in the lowest tertile (HbA1c = 8.6 ± 1.4 %; FPG = 170 ± 36 mg/dL; p < 0.01). Conversely, adherence to the Refined and processed pattern was positively associated with higher HbA1c and FPG levels. The Mixed-animal heavy pattern showed no significant associations.

CONCLUSION: Traditional, whole-food dietary patterns were associated with better glycemic control among T2DM patients, while refined and processed diets were linked with poorer outcomes. Promoting culturally appropriate, minimally processed dietary practices may enhance diabetes management in resource-limited regions of Northern Pakistan.

KEY TERMS: Azad Kashmir; Diabetes Mellitus, Type 2; Dietary Patterns; Gilgit-Baltistan; Glycated Hemoglobin A; Glycemic Control; Nutrition; Pakistan