Diabetes-Focused Examiner Questions

Question 1

Why might hPDI protect people with pre-diabetes but not those with diabetes?

Answer 1

Likely because in diabetes, there’s already established vascular and renal damage. The benefits of a high-quality plant diet may be blunted by reduced metabolic flexibility or kidney dysfunction.

Question 2

Why is cystatin C a key mediator in the diabetes group?

Answer 2

It’s a marker of renal dysfunction. The uPDI increased CVD risk partly through kidney stress—cystatin C explained 44% of the effect in diabetes, vs 15% in pre-diabetes.

Question 3

What clinical advice differs between pre-diabetes and diabetes from this study?

Answer 3

For pre-diabetes: raise healthy plant foods to gain CVD protection.
For diabetes: the priority is reducing ultra-processed plant foods (uPDI) and managing renal risk—diet change alone might not be enough.

Question 4

How was diabetes defined in the study?

Answer 4

Based on self-report, hospital records, medications, and/or HbA1c ≥ 6.5% (48 mmol/mol). Pre-diabetes was HbA1c 5.7–6.4%.

Question 5

Why might dietary impact be harder to detect in people with diabetes?

Answer 5

Confounding by disease duration, medication effects, and poorer kidney/metabolic health may mask or reduce the apparent diet–CVD link.

Question 6

Why exclude type 1 diabetes and gestational diabetes?

Answer 6

Different pathophysiology, smaller sample sizes, and lack of dietary comparability. Including them could dilute the findings.