Brief Research Review:
The role of the food environment in Type 2 Diabetes

Scrabble tiles spelling 'DIABETES' on a green rack surrounded by scattered tiles.

The global prevalence of type 2 diabetes has increased dramatically over the past two decades. According to the International Diabetes Federation, an estimated 589 million adults aged 20–79 had diabetes in 2024, with 90% of these cases being type 2 diabetes (T2DM) (1).

In tackling the burden of Type 2 diabetes, medical interventions have a significant role to play.  The 2025 meta-analysis by Nong and Colleagues provides evidence on 26 outcomes identified as important to patients regarding 13 drug classes (63 medications) for adults with T2DM (2).

However, the rising prevalence, and increasingly scarce healthcare resources, are a clear sign that more attention is needed to proactive, population level measures to prevent diabetes.  In particular, attention to the ‘food environment’ should be a priority for policy makers.

Types of food

A comprehensive umbrella review published in The BMJ synthesised findings from 53 meta-analyses of prospective observational studies. It found strong evidence that increased intake of whole grains and cereal fibre was associated with a reduced risk of developing T2DM. Conversely, higher consumption of red and processed meats, sugar-sweetened beverages, and bacon was linked to increased risk (3). These associations highlight how the composition of the food environment—particularly the prevalence of ultra-processed and high-sugar foods—can shape population-level diabetes outcomes.

Urban food environment

Urban food environments may be a particular priority for policymakers.  A UK Biobank study examined the link between exposure to ready-to-eat food environments and type 2 diabetes among 347,551 adults. Higher density of outlets like restaurants, cafeterias, and takeaways within 1 km of residence was associated with increased odds of type 2 diabetes, especially among overweight individuals. Conversely, greater street distance to such outlets showed a protective effect. The findings suggest that urban food environments influence diabetes risk and support policy interventions to limit unhealthy food access through planning regulations and nutritional standards (4).

Community Development

Local community development work is key to improving the food environment.  For example, The Sustainable Food Cities (SFC) Phase 2 evaluation highlights the programme’s transformative impact across 50 UK cities. SFC fostered robust local food partnerships, influenced policy, and leveraged over £3.5 million in additional funding. It supported campaigns like Sugar Smart and Sustainable Fish Cities, promoted knowledge exchange, and enhanced public engagement. Despite challenges such as limited resources, SFC demonstrated resilience and strategic influence in shaping sustainable food systems. The report underscores SFC’s role in creating cohesive, place-based food governance and its growing international relevance (5).

 

References

(1)    Gong JY, Sajjadi SF, Motala AA, Shaw JE, Magliano DJ. Variation in type 2 diabetes prevalence across different populations: the key drivers. Diabetologia. 2025 Aug 4. Available from: https://link.springer.com/article/10.1007/s00125-025-06478-4 

(2)    Nong K, Jeppesen BT, Shi Q, Agoritsas T, Guyatt GH, White H, et al. Medications for adults with type 2 diabetes: a living systematic review and network meta-analysis. BMJ. 2025;390:e083039. doi:10.1136/bmj-2024-083039 Available from: Medications for adults with type 2 diabetes: a living systematic review and network meta-analysis | The BMJ

(3)    Neuenschwander M, Ballon A, Weber KS, Norat T, Aune D, Schwingshackl L, Schlesinger S. Role of diet in type 2 diabetes incidence: umbrella review of meta-analyses of prospective observational studies. BMJ. 2019;366:l2368. Available from: https://www.bmj.com/content/366/bmj.l2368

(4)    Sarkar C, Webster C, Gallacher J. Are exposures to ready-to-eat food environments associated with type 2 diabetes? A cross-sectional study of 347,551 UK Biobank adult participants. Lancet Planet Health. 2018;2(10):e438–50. doi:10.1016/S2542-5196(18)30208-0. Available from: https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(18)30208-0/fulltext

(5)    Hills S, Jones M. Sustainable Food Cities Phase 2 Evaluation. Bristol: University of the West of England; 2019. Available from: https://www.sustainablefoodplaces.org/resources/files/documents/Hills_and_Jones_2019_SFC_Final_Report.pdf