Mediterranean diet adherence among adolescents with type 1 diabetes: Insights into dietary patterns, glycemic control, and gender differences

Aims: To assess Mediterranean Diet (MD) adherence in adolescents with type 1 diabetes)T1D(, explore its associations with glycemic control and cardiometabolic risk factors, and examine gender-specific dietary patterns. Methods: This cross-sectional study included 283 adolescents (45 % female) aged 15–19 years. MD adherence was evaluated using the KIDMED questionnaire. Clinical and demographic data were extracted from medical records. Results: Overall MD adherence was moderate (median KIDMED score 5.0). Only 19.1 % had high adherence, while 26.9 % had low adherence. Higher adherence was independently associated with continuous glucose monitoring (CGM) use (β = 0.195, 95 % CI 0.13–2.18; p = 0.027). Adolescents with HbA1c ≤ 7.0 % (≤53 mmol/mol) were more likely to use CGM (OR 2.49, 95 % CI 1.26–4.93; p = 0.009) and consume fast food infrequently (OR 2.03, 95 % CI 1.03–4.00; p = 0.042). Compared to males, females demonstrated higher MD adherence, characterized by higher vegetable consumption (OR 2.17, 95 % CI 1.26–3.72; p = 0.005) and lower frequency of fast-food restaurant visits (OR 0.56, 95 % CI 0.32–0.99; p = 0.047); yet, they also had higher BMI z-scores (OR 1.49, 95 % CI 1.12–1.98; p = 0.007). Conclusions: CGM use is associated with healthier dietary patterns, and reduced fast-food consumption is associated with better glycemic control. Gender disparities in diet and metabolic outcomes highlight the need for personalized, gender-sensitive nutritional strategies.