Background: Sodium, saturated fat, and sugar intake in Bangladesh is rising, primarily driven by increasing consumption of packaged foods high in these nutrients. A front-of-package nutrient warning label (FoPL) policy is being proposed by the national government to protect against rising rates of diet-related chronic disease. The government is seeking to develop evidence-based limits for sodium, sugar, and saturated fat to support this policy. Objective: To compare the proportion of packaged products that would receive FoPL when three nutrient profile models (NPM) are applied: the Brazil NPM and Chile NPM, based on product weight, and World Health Organization (WHO) NPM (modified from the Pan American Health Organization (PAHO) NPM), based on calories. All three NPMs divide liquids from solids but do not vary across food categories. Methods: Packaged foods and beverages in the Mintel Global New Products Database eligible for a FoPL and displaying information necessary to calculate nutrient content were evaluated. NPM limits were applied to each product. The proportions of products that would display FoPL for each nutrient under each NPM were calculated overall, for foods and beverages separately, and by product category. Results: The display of nutrient values varied across food categories. Among eligible food products, 15% lacked information on sodium content, 25-28% on saturated fat, and 21-26% on sugar (Figure 1). Among the three NPMs used, the Brazil NPM consistently captured fewer eligible products while the WHO NPM captured the most (Figure 2). A “high in sugar” FoPL would be applied to 92% of carbonated soft drinks using the WHO NPM, compared to 74% (Chile NPM) and 70% (Brazil NPM) (Figure 3). 58% of snacks would receive a “high in salt” FoPL (WHO NPM) compared to 50% (Chile NPM), and 29% (Brazil NPM) (Figure 3). Conclusions: The WHO NPM identifies the highest percentage of packaged foods and beverages in Bangladesh high in sodium, saturated fat, and sugar. Because it is grounded in WHO population nutrient intake goals for preventing diet-related chronic disease, it provides a health-protective basis for a FoPL system. This model ensures that the FoPL framework aligns with global public health standards and supports healthier food environments. Irrespective of NPM model used, stronger regulatory enforcement and compliance with nutrient disclosures on labels is needed for comprehensive product classification and effective FoPL policy implementation.

The World Health Organization recommends team-based care (TBC) for hypertension control, particularly in low-resourced settings. This study assessed current practices, task distribution, and perspectives on a team-based approach to hypertension management in Ghana. In this cross-sectional study, we used convenience sampling to disseminate the Resolve to Save Lives Survey (RTSL) online to healthcare workers (HCWs) involved in hypertension management. Hypertension task-complexity was conceptualized (administrative, basic, and advanced clinical tasks) based on the RTSL Team-Based Hypertension Care conceptual framework and stratified by HCWs and facility-level characteristics. Among 345 HCWs, the mean age was 34 (± 6.3), 58

Introduction: Consumption of packaged foods and beverages high in sodium, sugar, and saturated fat is increasing in Ethiopia. The Ethiopian government is considering a comprehensive policy package including front-of-pack labeling (FoPL), and restrictions on marketing and procurement to discourage purchase of products exceeding nutrient thresholds. The potential dietary and health impact of this policy is unknown. Objectives: To estimate the dietary and health impacts of implementing the policy package in Ethiopia. Methods: We applied a comparative risk-assessment model to simulate the impact of these policies among adults (≥20 years). Sales data from Euromonitor Passport Database were used as intake proxies, linked with sodium and sugar content from Mintel Global New Products Database. Historic trends were used to project future consumption, and policy-effect on nutrient sales were derived from a real-world evaluation of a similar policy package. Reductions in sodium and sugar intake were used to estimate changes in blood pressure and body-mass index using data from clinical trials, and then converted into averted deaths and disability-adjusted life years (DALYs) using data from global databases and a national survey. Outcomes were estimated for 2025 and 2040 under two packaged food consumption scenarios: current trends (low) and 10% annual growth observed in other middle-income countries (high). Results: Without the policy package, sodium intake from packaged foods is projected to rise from 98 (95% uncertainty interval: 77-119) mg/day (2025) to 125 (96-157) mg/day (low) or 406 (319-500) mg/day (high) by 2040, and sugar from 6.1 (5.7-6.6) g/day to 7.6 (7.0-8.1) g/day (low) or 25.7 (24.1-27.3) g/day (high) ( Figure 1 ). Without policy action, these increases could raise noncommunicable disease (NCD) burden, especially from cardiovascular diseases ( Figure 2 ). Immediate implementation of the policy package could reduce sodium intake by 23% (19–27%) and sugar by 27% (25–29%), averting 384 (253–556) deaths and 5,145 (3,739–6,930) DALYs. Projected benefits substantially increase for both low- and high-trends by 2040 ( Figure 3 ). Conclusions: A policy package including FoPL plus marketing and procurement restrictions, could yield immediate, meaningful health gains in Ethiopia. By 2040, under either current trends or 10% annual growth in packaged-food consumption, these policies could attenuate the projected rise in NCDs driven by sodium and sugar in packaged foods.

Introduction: Lactate is a major mitochondrial fuel source, the main precursor for gluconeogenesis, and a multifunctional signaling molecule. Elevated circulating lactate is associated with increased type 2 diabetes (T2D) risk, and dietary carbohydrate changes can alter lactate in people without T2D. Whether the Dietary Approaches to Stop Hypertension (DASH) diet alters circulating lactate, and/or fecal lactate (reflecting gut microbial fiber fermentation), is not known. Further, whether these changes correlate with liver function, as the liver converts lactate to glucose via gluconeogenesis, is unknown. Hypotheses: A high-fiber DASH-style diet will lower plasma lactate and raise fecal lactate; reduced sodium intake will not affect either outcome. Plasma lactate will be positively correlated with glucose and liver enzymes. Methods: DASH4D is a randomized 4-period crossover feeding trial of a DASH-style diet modified for people with T2D (DASH4D diet) vs. typical U.S. (comparison) diet, each with a higher and lower sodium version, among 102 adults with T2D. Plasma and fecal samples were collected pre-randomization and at the end of each 5-week feeding period. Lactate was measured using gas chromatography-mass spectrometry (MS)/MS. We used linear mixed effects models to examine effects of diet and sodium content on end-of-period plasma and fecal lactate. We assessed within-individual correlations between lactate, glucose, and liver enzymes (alanine (ALT) and aspartate (AST) aminotransferases, gamma glutamyl transferase (GGT), and alkaline phosphatase (ALP)) using repeated-measures correlations analysis. Results: There were 97 participants (mean age 67 (sd: 8.9) years, 66% female, 89% Black) with plasma, and of those 83 with fecal, samples from both pre-randomization and ≥2 feeding periods. The DASH4D (vs. comparison) diet lowered plasma lactate by -86.0 µM (95%CI:-168.9, -3.2), while sodium content had no effect ( Figure 1 ). Neither the DASH4D diet nor sodium content affected fecal lactate. Plasma, but not fecal, lactate was positively associated with glucose and liver enzymes ALT, AST, and GGT ( Figure 2 ). Conclusions: The DASH4D diet lowered plasma, but not fecal, lactate in adults with T2D. These results suggest that dietary effects on plasma lactate are related to endogenous metabolism, not bacterial lactate production. Plasma lactate positively correlated with glucose and liver enzymes, further implicating changes in host metabolic processes with DASH4D diet.

Background: The effects of reducing dietary carbohydrate intake and glycemic index (GI) levels on temporal changes in blood metabolomic profiles and their impact on improving glucose tolerance remain unclear. Aim: We examined temporal changes in circulating metabolites induced by lowering dietary carbohydrate content and GI levels and aimed to identify specific metabolites associated with improved glucose tolerance and insulin sensitivity. Methods: We analyzed data from 162 adults in the OmniCarb trial, a crossover feeding study of diets varying in carbohydrate amount and GI levels. Each diet was consumed for 5 weeks, with at least a 2-week washout period. Global metabolomics was repeatedly performed to calculate temporal changes. Oral glucose tolerance tests (OGTTs) were conducted for all participants; 12-hour meal tests were performed in a subsample (n=59). To validate and explore long-term associations in an independent study (n=670), we analyzed 6-month changes in metabolites in response to weight-loss diets varying in macronutrient composition among participants in the POUNDS Lost trial. Results: At baseline, 189 of 906 analyzed metabolites showed suggestive associations (crude p <0.05) for the area under the curve of glucose during the OGTT, and 51 metabolites remained significant after correcting for multiple testing (P-FDR <0.05). We found that 170 metabolites (19%) after overnight fasting were significantly modified by lowering carbohydrate amount and GI. In addition, at 30 minutes post-meal (after breakfast), 101 metabolites changed significantly, indicating that the low-carbohydrate, low-GI diet altered postprandial metabolite responses. Particularly, changes in gut microbiota-related metabolites, including 3-hydroxybutyrate, 3-aminoisobutyrate, kynurenate, N-acetylglycine, and hippurate, were associated with improved 12-hour postprandial glucose responses following the low-carbohydrate, low-GI diet. In the POUNDS Lost trial, 6-month increases in 3-hydroxybutyrate, 3-aminoisobutyrate, and N-acetylglycine were associated with greater reductions in fasting glucose and insulin resistance at 6 months. These initial (6-month) metabolite changes were associated with 2-year improvements in glucose metabolism and insulin sensitivity. Conclusions: Dietary interventions focusing on carbohydrate amount and GI altered circulating metabolites, including gut microbiota-related metabolites, which were linked to improved glucose tolerance and insulin sensitivity.

Background: In rural Bangladesh, there are several challenges to improving hypertension treatment coverage and control, particularly the scarcity of physicians and centralized delivery of hypertension care, which requires patients to travel a long distance to healthcare facilities (Upazila Health Complexes [UHC]). Aim: To assess the feasibility of implementing a community-based (CB) WHO HEARTS package involving non-physician health workers (Community Healthcare Providers [CHCP]) to diagnose and treat patients with hypertension in Community Clinics (CC) under telemedicine supervision and guidance of a UHC physician. Methods: This single-arm pilot study was conducted in four CCs in rural Bangladesh among adults with untreated hypertension [blood pressure (BP) 140-180/90-110 mmHg]. The CB-HEARTS package intervention components were 1) simplified treatment protocol, 2) reliable medication supply, 3) team-based care, 4) standardized follow-up, and 5) an information system to track patients’ BP control. Through teleconsultancy, CHCPs communicated with designated UHC physicians to confirm the diagnosis of hypertension and initiate treatment with amlodipine 5 or 10 mg/day in the CC. Patients with controlled BP (<140/90 mmHg) during follow-up were provided a 3-month medication refill. Patients with complications or uncontrolled BP after medication titration according to the treatment protocol were referred to the UHC. Enrollment and retention rates were primary outcomes, and BP change and hypertension control were secondary. Results: Of 244 who were eligible, 220 (90.2%) individuals with hypertension were enrolled (mean age 56±13.8 years, 76% female). Overall, 97% of enrolled participants started medication treatment. Retention rates at the CC were 88%, 88%, and 85% at 3, 6-12, and 12-18 months, respectively ( Table ). Mean systolic/diastolic BP was 153/92 mmHg at enrollment. BP was lowered by ~35 mmHg systolic and ~18 mmHg diastolic ( Figure ) over 18 months of follow-up. The hypertension control rate was ~98% during the follow-up among patients retained in the program. Conclusions: This pilot study indicates decentralized hypertension care delivered by non-physician health workers through remote supervision of physicians is feasible to implement and may considerably improve hypertension control in rural Bangladesh. A randomized trial to test the safety, effectiveness, and acceptability is warranted.

Background: To massively scale up efforts to diagnose and treat hypertension, different screening strategies have been proposed (population-wide screening campaigns and healthcare facility-based “opportunistic” screening). However, no studies have compared their impact on cardiovascular disease (CVD) prevention in low-resource settings. Objective: To compare hypertension treatment coverage, CVD events, and CVD deaths in Bangladesh from three different screening strategies. Methods: We developed a discrete-time microsimulation model populated with data from the 2018 Bangladesh WHO STEPS survey. Over 10 years, hypertension diagnosis and treatment, CVD events (strokes and ischemic heart disease), and deaths were estimated for a model population (100,000 adults without hypertension diagnosis or CVD history) under 3 scenarios: (1) current practice of limited opportunistic screening in public healthcare facilities (20% of patients screened); (2) extended opportunistic screening in public healthcare facilities (80% of patients screened); and (3) one-time population-wide screening targeting 80% population coverage over 5 years. In (1) and (2), patients visiting public healthcare facilities (30% of population) could be screened multiple times over the 10 years. Ten-year CVD risk was calculated using WHO CVD prediction models recalibrated with country-specific Global Burden of Disease data. Results: Under current practice, 22,129 adults (out of N=100,000) could be screened over 10 years and 2,002 would start treatment ( Figure, Panels A and B ); in this scenario, 12,117 CVD events and 1,548 deaths would occur. In the extended opportunistic screening scenario, 62,680 adults would be screened and 6,222 would initiate treatment. With population-wide screening, 79,482 would be screened, and treatment would begin in 3,171 adults. Compared to current practice ( Panels C and D ), extended opportunistic screening and population-wide screening could prevent 65 and 46 more CVD events, and 33 and 22 CVD deaths per 100,000 over 10 years, respectively. Among adults aged ≥40 years (40% of the total population), the estimated impact on CVD burden was doubled (e.g., 65-70 averted CVD deaths per 100,000). Conclusion: Despite the intuitive appeal of population-wide screening, the most effective screening strategy to increase screening yield and prevent CVD events in Bangladesh and likely other low-resource settings is extended opportunistic screening in public health care facilities.

Background: The Dietary Approaches to Stop Hypertension for Diabetes (DASH4D) trial showed that a DASH-style diet vs. typical US comparison diet improved glycemia in adults with type 2 diabetes. The biological mechanism may include microbial production of short-chain fatty acids (SCFAs), which have been associated with improved glycemia. Objective: The aim of this study is to evaluate the effects of a DASH-style diet vs. comparison diet on SCFAs in stool and plasma. We hypothesized that the DASH-style diet increases SCFAs. Methods: DASH4D is a randomized 4-period crossover feeding study among adults with type 2 diabetes, a systolic blood pressure of 120-159 mmHg, and a diastolic blood pressure of <100 mmHg. The DASH4D diet is a DASH-style diet modified for adults with type 2 diabetes (i.e., with lower carbohydrates, higher unsaturated fat, and lower potassium than the original DASH diet). Participants were randomized to a sequence of four 5-week diets: (1) DASH4D with lower sodium, (2) DASH4D with higher sodium, (3) comparison diet with lower sodium, and (4) comparison diet with higher sodium. Our primary interest was DASH4D vs. comparison diets. Outcomes were SCFAs measured in stool and plasma, collected at baseline and at the end of each diet period. We measured SCFAs in plasma and in feces using gas chromatography-mass spectrometry. We normalized SCFAs using log transformation. We fit linear mixed effects models to examine mean log-transformed SCFAs at the end of each diet period. Results: There were 97 participants with plasma samples (and of those, 83 with fecal samples) from both pre-randomization and 2 or more feeding periods. Of these 97 participants, 66% were female and 89% self-identified as Black. Mean age was 67 (SD 8.9) years. There was no evidence interaction between diet and sodium level, so we present unstratified results. Relative to the comparison diet, the DASH4D diet increased plasma acetate by 8.7% (95%CI: 1.3%-16.7%). No other SCFAs were changed in the plasma or in the stool ( Fig. 1 ). Sodium level of diet did not affect SCFAs in plasma or stool ( Fig. 2 ). Conclusion: In adults with type 2 diabetes, the DASH4D diet increased plasma acetate, but not other plasma SCFAs. Null effects on stool SCFAs are consistent with animal studies that show SCFAs may be reabsorbed in the colon when plasma SCFAs increase. Research is needed to understand if changes in plasma acetate mediates the health effects (e.g., glycemic effects) of a DASH-style diet.

Background: In a recent controlled feeding trial, we showed that a DASH-style diet tailored for individuals with type 2 diabetes (DASH4D diet) improved short-term glycemic control assessed by continuous glucose monitoring. In this secondary analysis of the trial, we examined the effect of the DASH4D diet on biomarkers of glycemia. Methods: In the DASH4D trial, adults with type 2 diabetes were fed four isocaloric diets in a random order: DASH4D diet or comparison diet (representative of a typical American diet), each with higher or lower sodium. Each feeding period lasted 5 weeks and was separated by ≥1 week break. The primary outcome in this analysis was fructosamine, a marker reflecting glycemia over the past 2-3 weeks. Secondary outcomes included fasting glucose (reflecting glycemia at a single moment) and HbA1c (reflecting glycemia over 2-3 months). Outcomes were assessed at the end of each feeding period. Using an intention-to-treat approach, we estimated the effect of the DASH4D (versus comparison) diet on all outcomes with linear mixed effect models. In exploratory analyses, we examined the effect of the DASH4D diet by baseline HbA1c. Results: We included 101 participants (mean age: 67 years; 65% female; 88% Black adults). At baseline, mean HbA1c was 7.0% and 55% of participants were using two or more glucose-lowering medications. Compared to the comparison diet, the DASH4D diet significantly reduced end-of-period fructosamine (adjusted difference: -5.6 umol/L, P<0.002) and fasting glucose (adjusted difference: -4.5 mg/dL; P=0.019) (Figure A1-A2) . The DASH4D diet also had a small effect on HbA1c (adjusted difference: -0.09 %-points; P=0.035) (Figure A3) ; however, the 5-week duration of the feeding periods was suboptimal for estimating the effect of the diets on HbA1c. The effect of the DASH4D diet on fructosamine and fasting glucose was larger for participants with higher baseline HbA1c (Figure B1-B3) . Conclusion: The DASH4D diet significantly lowered fructosamine and fasting glucose in adults with type 2 diabetes. These results support the inclusion of the DASH4D dietary pattern into policy and clinical guidelines to improve glycemic control in type 2 diabetes.

Background: Understanding the prevalence and risk factors for hyperkalemia is critical for public health policy, especially given the burgeoning interest in use of potassium-enriched salt substitutes as a means to reduce sodium intake. Importantly, data on the prevalence of hyperkalemia in the US are sparse, overall and in high-risk subgroups. Aim: To investigate the prevalence, temporal trends, and risk factors for hyperkalemia in the US using nationally representative data. Method: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2001 through 2023. Hyperkalemia was defined as a serum potassium levels >5.0 mmol/L. Prevalence of hyperkalemia was estimated overall and by survey cycle using logistic regression. Candidate predictors of hyperkalemia, including hypertension, chronic kidney disease (CKD), diabetes, sex, age, race/ethnicity, alcohol use, smoking status, renin–angiotensin–aldosterone system (RAAS) inhibitors, were examined in crude models. Then, significant factors were incorporated simultaneously in a multivariable model and presented, along with the prevalence of hyperkalemia in each relevant subgroup. All analyses incorporated sampling weights. Results: Among 45,778 U.S. adults aged 20 years and older pooled across the 2001–2023 NHANES survey cycles, 373 had hyperkalemia. The overall prevalence of hyperkalemia was 0.46% (95% CI 0.29-0.71%). Although the prevalence of hyperkalemia appeared to be increasing from 0.16% (0.07-0.33%) in 2005-2006 to 0.75% (0.46-1.21%) in 2017-2020 ( Figure ), in the entire two decades, its prevalence was largely constant between 0.3% and 0.6%, with no clear temporal trend ( P for trend = 0.07). Factors significantly associated with hyperkalemia included CKD, older age, and male sex ( Table ). Non-White racial/ethnic groups and current alcohol users showed lower prevalence compared to their counterparts. The only subgroups with the prevalence of hyperkalemia exceeding 1% were people with CKD and older adults (≥65 years). Conclusion: The overall low prevalence of hyperkalemia without evident temporal trend supports the safety of promoting potassium-enriched salt substitutes among U.S. adults. However, careful implementation may be warranted for individuals with risk factors, such as CKD, older age, and male sex. In contrast, racial/ethnic minorities and current alcohol users showed a lower prevalence of hyperkalemia and could particularly benefit from potassium-enriched salt substitutes.

Backgrounds: The Dietary Approaches to Stop Hypertension for Diabetes (DASH4D) diet, a DASH-style diet adapted for people with diabetes, improved glycemia in people with type 2 diabetes. Here we conducted a metabolome-wide analysis to examine the effects of the DASH4D diet on plasma and fecal metabolites in adults with type 2 diabetes. Methods: In a 4-period crossover feeding trial, we randomized 105 participants with type 2 diabetes to a random sequence of 4 diets: the DASH4D diet or a typical US comparison diet, each with a higher and lower sodium version, for 5 weeks each. Participants provided plasma and fecal specimens prior to randomization and at the end of each diet period. We measured metabolites using Metabolon’s UPLC-MS/MS. We included in the analysis participants who finished at least one DASH4D diet and one comparison diet. We used linear mixed effects models to assess associations of diet and sodium interventions with each metabolite. Statistical significance was defined using an FDR-adjusted p<0.05. Results: A total of 92 and 95 participants were included in the fecal and plasma metabolomic analyses, respectively. On average, participants were 66.5 years, 67.3% female, and 87.4% Black. A total of 206 of 739 (27.9%) fecal metabolites significantly differed between the DASH4D and comparison diets, with 28 having >2-fold effect sizes; 279 of 1160 (24.1%) plasma metabolites significantly differed between diets, with 11 having >2-fold effect sizes ( Fig. 1 ). Of the top 20 most affected metabolites in fecal and plasma, 5 overlapped ( Fig. 2 ). Of a priori interest, the metabolite imidazole propionate, which is microbially-produced and related to dysglycemia, was lower in the DASH4D vs comparison diet by 52.2% (95% CI: 29.0-67.9%) in feces and by 14.8% (3.4-24.9%) in plasma. In comparison, only 76 of 1160 (6.6%) plasma metabolites and no fecal metabolites significantly differed between lower vs higher sodium diets ( Fig. 3 ). Conclusions: In adults with type 2 diabetes, the DASH4D diet affected a high proportion of metabolites measured in plasma and in feces. Several of the metabolites affected by diet, including imidazole propionate, changed in similar direction in fecal and plasma samples, suggesting the effects derive in the gut. Dietary sodium, on the other hand, affected only plasma metabolites, and the effects were smaller in magnitude. These findings may help to elucidate diet-disease pathways and identify biomarkers of healthful dietary patterns.

Introduction: In a recent randomized trial, we showed that a DASH-style diet optimized for adults with type 2 diabetes (DASH4D) reduced mean glucose assessed by continuous glucose monitoring (CGM). However, the impact of DASH4D on postprandial glycemic response (PPGR), or glucose dynamics following meal taking, is unclear. Objective: Quantify the effect of the DASH4D diet on the PPGR time series and evaluate the proportion of the overall glycemic benefit of the DASH4D diet attributable to PPGR. Methods: The DASH4D trial had a 4-period crossover design. Adults with type 2 diabetes were randomized to an order of four diets: DASH4D or a typical American dietary pattern (comparison), each with lower or higher sodium. Calories were adjusted to maintain a stable weight. As sodium was not expected to impact PPGR, we combined the lower and higher sodium arms within each diet. Feeding periods were 5 weeks, with ≥ 1 week break between periods. CGM devices were worn from the 3 rd to 5 th weeks, recording up to 14 days of data. In a subset of participants, staff recorded meal timing during CGM wear. We fit a functional model regressing the PPGR time series (CGM glucose 1 hour before to 4 hours after meal start time) on diet type, including participant-specific random effects and adjustment for age, sex, body mass index (BMI), and time of day. We also applied functional regression-based mediation analyses to estimate the proportion of the diet effect on mean glucose that was mediated by differences in PPGR. Results: We collected PPGR data from 768 meals across the 65 participants who consented to meal monitoring (median age 68 years, 66% female). The DASH4D diet reduced PPGR, ranging from a difference -4.5 mg/dL at meal onset to -14.7 mg/dL from 1-2 hours after the start of the meal ( Fig. 1a ). There was a significant difference in PPGR between the DASH4D and comparison diets over the entire observation period ( Fig. 1b ). Differences in PPGR mediated 88% of the overall effect of the DASH4D diet on CGM mean glucose ( Fig. 2 ). Conclusion: Among adults with type 2 diabetes, the DASH4D diet improved glycemic control primarily by reducing PPGR.

OBJECTIVE:To examine the effect of the Dietary Approaches to Stop Hypertension for Diabetes (DASH4D) diet (a DASH-style diet tailored for diabetes) on biomarkers of glycemia. RESEARCH DESIGN AND METHODS:In this controlled feeding trial, adults with type 2 diabetes were fed four diets in a random order: DASH4D diet and comparison diet (representative of a typical American diet), each with higher and lower sodium. Each feeding period lasted 5 weeks. Using a modified intention-to-treat approach, we estimated the effect of the DASH4D (versus comparison) diet on fructosamine, fasting glucose, and HbA1c with linear mixed-effects models. RESULTS:Among 101 participants (mean age 67 years, 65% female, 87% Black adults), compared with the comparison diet, the DASH4D diet significantly reduced end-of-period fructosamine (adjusted difference: -5.6 μmol/L, P = 0.002), fasting glucose (adjusted difference: -4.5 mg/dL; P = 0.02), and HbA1c (adjusted difference: -0.09 percentage points; P = 0.04). CONCLUSIONS:Our results support recommending the DASH4D diet for glycemic management in type 2 diabetes.