Relationship between Mediterranean diet adherence and triglyceride-glucose index in adult Type 2 Diabetic patients followed at Trakya University Hospital

One of the most challenging elements of diabetes management in primary care is objectively monitoring patients' adherence to lifestyle changes. Adherence to medical nutrition therapy within the scope of lifestyle changes is a key determinant for successful diabetes treatment. The aim of this study is to investigate the clinical utility of the Triglyceride-Glucose (TyG) index, calculated with simple biochemical parameters (fasting sugar and triglycerides), as a dietary adherence monitoring tool indicating adherence to the Mediterranean diet in patients with Type 2 diabetes. This cross-sectional study was conducted with 252 Type 2 diabetic patients followed at the Diabetes and Obesity Outpatient Clinic of Trakya University Hospital between November 2024 and April 2025. Patients' nutritional patterns were scored using the Mediterranean Diet Adherence Screener (MEDAS), and metabolic status was analyzed using the TyG index calculated from the most recent laboratory data within the last six months in the hospital management information system. In the statistical evaluation, the effect of dietary components was examined using stepwise regression, and the discriminative power of the index using ROC analysis. A very strong inverse correlation was found between the MEDAS total score and the TyG index in the study group (r = -0.765; p <0.001). Regression analyses revealed that the most effective dietary habits for lowering the TyG index were the restriction of sugary/carbonated drinks, use of olive oil as the main fat, and consumption of nuts. The most striking finding of the study was that patients with a TyG value below 8.97 could be predicted to have strong adherence to the Mediterranean diet (MEDAS ≥9) with 85.7% sensitivity and 85% specificity. Furthermore, this study demonstrated the effectiveness of regular physical activity and its frequency on both dietary adherence and insulin resistance. The TyG index is a reliable biomarker reflecting not only insulin resistance but also the patient's nutritional discipline in Type 2 diabetic patients. Our study demonstrates that reducing this index below the value of 8.97 can return patients' metabolic profiles to pre- diabetic risk levels (metabolic reset). Family physicians can objectively monitor dietary adherence using the TyG index without the need for costly tests.