Assessment of inequities by geolocation: mediterranean diet and type 2 diabetes

Background

High adherence to Mediterranean diet is a strong, independent predictor of improved glycemic control, reduced cardiovascular risk, and optimized lipid profiles in type 2 diabetes (T2D) patients. By representing geographical data, we seek to detect inequalities in adherence to the Mediterranean diet in Extremadura (Spain).

Methods

As part of JACARDI (Joint Action on Cardiovascular diseases and diabetes), the MAP-IT pilot project surveyed people with diabetes using validated questionnaires to capture information not found in standard clinical records, enriched the results and drew them in maps. It aimed to identify differences across health areas in the region of Extremadura. In this analysis, we focused specifically on dietary habits in people having T2D and the factors influencing those differences. To analyse adherence to the Mediterranean diet, the MEDAS questionnaire was used, dividing the sample into good and poor adherence groups. After geospatial representation, a multivariate logistic regression model was constructed, with dietary adherence as the dependent variable.

Results

Among 309 people with T2D (mean age 59.7, SD 16.3; 57.9% women), 41.1% had poor Mediterranean diet adherence without significant differences between health areas. However, a North–South pattern was found, with poorer adherence concentrated in the North (p=0.053). Adjusting for financial ease homogenized central/southern areas, but northern areas still showed poorer adherence. In a logistic regression including location, education, social deprivation index, financial scale, and area income, only social deprivation index (p=0.02) was significantly associated with poor adherence; financial scale (p=0.06) and low education (p=0.07) were borderline.

Conclusions

Geolocating data helps interpret results and target improvements to reduce inequalities. For Mediterranean diet adherence, awareness campaigns and social isolation prevention could mitigate the problem in Extremadura.

Key messages

• Geolocating dietary data reveals north–south adherence patterns in Extremadura, guiding targeted inequality-reducing campaigns.

• Poor Mediterranean diet adherence in type 2 diabetes is linked to social deprivation, not just geography (41.1% poor adherence).