Effects of low-carbohydrate- compared with low-fat-diet interventions on metabolic control in people with type 2 diabetes: a systematic review including GRADE assessments

ABSTRACT Background It remains uncertain which diet is best for people with type 2 diabetes (T2D). Objective We compared the effects of dietary carbohydrate restriction with fat restriction on markers of metabolic syndrome and quality of life in people with T2D. Design This systematic review of randomized controlled trials (RCTs) and controlled clinical trials (CCTs) compares the effects of a low-carbohydrate [≤40% of energy (%)] diet with those of a low-fat (≤30%) diet over a period of ≥4 wk in patients with T2D. Two investigators independently selected studies, extracted data, and assessed risk of bias. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach was used to assess the certainty of evidence. Pooled mean differences (MDs) and 95% CIs were calculated with the use of a random-effects model. Results Thirty-three RCTs and 3 CCTs (n = 2161) were included. Glycated hemoglobin declined more in people who consumed low-carbohydrate food than in those who consumed low-fat food in the short term (MD: –1.38%; 95% CI: –2.64%, –0.11%; very-low-certainty evidence). At 1 y, the MD was reduced to –0.36% (95% CI: –0.58%, –0.14%; low-certainty evidence); at 2 y, the difference had disappeared. There is low to high (majority moderate) certainty for small improvements of unclear clinical importance in plasma glucose, triglycerides, and HDL concentrations favoring low-carbohydrate food at half of the prespecified time points. There was little to no difference in LDL concentration or any of the secondary outcomes (body weight, waist circumference, blood pressure, quality of life) in response to either of the diets (very-low- to high-certainty evidence). Conclusions Currently available data provide low- to moderate-certainty evidence that dietary carbohydrate restriction to a maximum of 40% yields slightly better metabolic control of uncertain clinical importance than reduction in fat to a maximum of 30% in people with T2D. This systematic review is registered at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017052467 as CRD42017052467.

Download Full-text

Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data

BMJ ◽

10.1136/bmj.m4743 ◽

2021 ◽

pp. m4743

Author(s):

Joshua Z Goldenberg ◽

Andrew Day ◽

Grant D Brinkworth ◽

Junko Sato ◽

Satoru Yamada ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Type 2 Diabetes ◽

Weight Loss ◽

Meta Analysis ◽

Risk Of Bias ◽

Low Carbohydrate ◽

Remission Of Diabetes

Abstract Objective To determine the efficacy and safety of low carbohydrate diets (LCDs) and very low carbohydrate diets (VLCDs) for people with type 2 diabetes. Design Systematic review and meta-analysis. Data sources Searches of CENTRAL, Medline, Embase, CINAHL, CAB, and grey literature sources from inception to 25 August 2020. Study selection Randomized clinical trials evaluating LCDs (<130 g/day or <26% of a 2000 kcal/day diet) and VLCDs (<10% calories from carbohydrates) for at least 12 weeks in adults with type 2 diabetes were eligible. Data extraction Primary outcomes were remission of diabetes (HbA 1c <6.5% or fasting glucose <7.0 mmol/L, with or without the use of diabetes medication), weight loss, HbA 1c , fasting glucose, and adverse events. Secondary outcomes included health related quality of life and biochemical laboratory data. All articles and outcomes were independently screened, extracted, and assessed for risk of bias and GRADE certainty of evidence at six and 12 month follow-up. Risk estimates and 95% confidence intervals were calculated using random effects meta-analysis. Outcomes were assessed according to a priori determined minimal important differences to determine clinical importance, and heterogeneity was investigated on the basis of risk of bias and seven a priori subgroups. Any subgroup effects with a statistically significant test of interaction were subjected to a five point credibility checklist. Results Searches identified 14 759 citations yielding 23 trials (1357 participants), and 40.6% of outcomes were judged to be at low risk of bias. At six months, compared with control diets, LCDs achieved higher rates of diabetes remission (defined as HbA 1c <6.5%) (76/133 (57%) v 41/131 (31%); risk difference 0.32, 95% confidence interval 0.17 to 0.47; 8 studies, n=264, I 2 =58%). Conversely, smaller, non-significant effect sizes occurred when a remission definition of HbA 1c <6.5% without medication was used. Subgroup assessments determined as meeting credibility criteria indicated that remission with LCDs markedly decreased in studies that included patients using insulin. At 12 months, data on remission were sparse, ranging from a small effect to a trivial increased risk of diabetes. Large clinically important improvements were seen in weight loss, triglycerides, and insulin sensitivity at six months, which diminished at 12 months. On the basis of subgroup assessments deemed credible, VLCDs were less effective than less restrictive LCDs for weight loss at six months. However, this effect was explained by diet adherence. That is, among highly adherent patients on VLCDs, a clinically important reduction in weight was seen compared with studies with less adherent patients on VLCDs. Participants experienced no significant difference in quality of life at six months but did experience clinically important, but not statistically significant, worsening of quality of life and low density lipoprotein cholesterol at 12 months. Otherwise, no significant or clinically important between group differences were found in terms of adverse events or blood lipids at six and 12 months. Conclusions On the basis of moderate to low certainty evidence, patients adhering to an LCD for six months may experience remission of diabetes without adverse consequences. Limitations include continued debate around what constitutes remission of diabetes, as well as the efficacy, safety, and dietary satisfaction of longer term LCDs. Systematic review registration PROSPERO CRD42020161795.

Download Full-text

Related factors of quality of life of type 2 diabetes patients: a systematic review and meta-analysis

Health and Quality of Life Outcomes ◽

10.1186/s12955-018-1021-9 ◽

2018 ◽

Vol 16 (1) ◽

Cited By ~ 22

Author(s):

Xiyue Jing ◽

Jiageng Chen ◽

Yanan Dong ◽

Duolan Han ◽

Haozuo Zhao ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Type 2 Diabetes ◽

Meta Analysis ◽

Related Factors ◽

Diabetes Patients

Download Full-text

Effects of exercise training on quality of life, symptoms of depression, symptoms of anxiety and emotional well-being in type 2 diabetes mellitus: a systematic review

Diabetologia ◽

10.1007/s00125-013-2871-7 ◽

2013 ◽

Vol 56 (6) ◽

pp. 1210-1225 ◽

Cited By ~ 36

Author(s):

M. M. P. van der Heijden ◽

F. E. P. van Dooren ◽

V. J. M. Pop ◽

F. Pouwer

Keyword(s):

Quality Of Life ◽

Diabetes Mellitus ◽

Systematic Review ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Well Being ◽

Depression Symptoms ◽

Symptoms Of Depression

Download Full-text

Predictors of quality of life in people living with type-1 and type-2 diabetes: An Indian perspective study and systematic review

Clinical Diabetology ◽

10.5603/dk.a2021.0057 ◽

2021 ◽

Author(s):

Deep Dutta ◽

Deepak Khandelwal ◽

Dimpy Jain ◽

Soniya Chahal ◽

Preeti Kuniyal ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Type 2 Diabetes ◽

Indian Perspective

Download Full-text

Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2016-000354 ◽

2017 ◽

Vol 5 (1) ◽

pp. e000354 ◽

Cited By ~ 113

Author(s):

Ole Snorgaard ◽

Grith M Poulsen ◽

Henning K Andersen ◽

Arne Astrup

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Meta Analysis ◽

Carbohydrate Restriction ◽

Dietary Carbohydrate

Download Full-text

Comparing effects of continuous glucose monitoring systems (CGMs) and self monitoring of blood glucose (SMBG) among adults with type 2 diabetes mellitus: A systematic review protocol

10.21203/rs.3.rs-17281/v1 ◽

2020 ◽

Author(s):

Mingyue Zheng ◽

Yunting Luo ◽

Wei Lin ◽

Adeel Khoja ◽

Qian He ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Type 2 Diabetes ◽

Blood Glucose ◽

Glucose Control ◽

Diabetes Management ◽

Self Monitoring ◽

Glucose Levels

Abstract Background: Continuous glucose monitors (CGMs) have been used to manage diabetes with reasonable glucose control among patients with type 2 diabetes (T2D) in recent decades. CGM systems measure interstitial fluid glucose levels to provide information about glucose levels, which identifies fluctuation that would not have been identified with conventional self-monitoring. Self-monitoring of blood glucose (SMBG) is a classical tool to achieve glycaemic control. However, the effectiveness of glucose control, costs, and quality of life are needed to evaluate and compare CGM and SMBG among adults with T2D.Methods: The review will compare the various forms of CGM systems (i.e flash-CGM, real-time-CGM, retrospective-CGM) versus SMBG/usual intervention regarding diabetes management among adults with T2D. The following databases will be searched: Cochrane Library, Science Direct, PubMed, EMBASE, CINAHL, PsycINFO, Scopus and grey literature for the identification of studies. The studies involving adults (aged ≥ 18 years old) will be included. We will include and summararize randomised clinical trials (RCTs) with respect to authors, publication type, year, status, and type of devices. Studies published in English between February 2010 and March 2020 will be included as the field of CGMs among T2D patients has emerged over the last decade. Primary outcomes that will be measured will be; HbA1c, body weight, time spent with hypoglycaemia or hyperglycaemia, blood pressure, quality of life. Secondary outcome measured will be morbidity, all-cause mortality, user satisfaction, and barriers. Study selection, data extraction, and risk of bias assessment will be conducted independently by at least two authors. A third author will determine and resolve discrepancies. Moreover, the quality of the evidence of the review will be assessed according to the Grading of Recommendations Assessment, Development and Evaluation Tool (GRADE).Discussion: The systematic review will synthesise evidence on the comparison between using CGMs and SMBG. The results will support researchers and health care professionals to determine the most effective methods/technologies in the overall diabetes management. Moreover, this review will provide more detailed information about the barriers of using CGMs to improve implementation.Systematic review registration: PROSPERO CRD42020149212

Download Full-text

Effect of Tai Chi on Quality of Life, Body Mass Index, and Waist-Hip Ratio in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Frontiers in Endocrinology ◽

10.3389/fendo.2020.543627 ◽

2021 ◽

Vol 11 ◽

Author(s):

Jiawei Qin ◽

Yannan Chen ◽

Shuai Guo ◽

Yue You ◽

Ying Xu ◽

...

Keyword(s):

Quality Of Life ◽

Diabetes Mellitus ◽

Systematic Review ◽

Type 2 Diabetes ◽

Body Mass Index ◽

Type 2 Diabetes Mellitus ◽

Tai Chi ◽

Meta Analysis

BackgroundType 2 diabetes mellitus (T2DM) is a worldwide public health concern with high morbidity and various progressive diabetes complications that result in serious economic expenditure and social burden. This systematic review aims to evaluate the effect of Tai Chi on improving quality of life (QoL), body mass index (BMI) and waist-hip ratio (WHR) in patients with T2DM.MethodA systematic review and meta-analysis was performed following PRISMA recommendation. Four English databases and three Chinese databases were searched. The PEDro scale was used to assess the methodological quality of including studies. Study inclusion criteria: randomized controlled trials (RCTs) and quasi-experimental studies were included, patients with T2DM that adopted Tai Chi as intervention and QoL, BMI and/or WHR as outcome measurements.ResultsEighteen trials were included. The aggregated results of seven trials showed that Tai Chi statistically significantly improved QoL measured by the SF-36 on every domains (physical function: MD = 7.73, 95% confidence interval (CI) = 1.76 to 13.71, p = 0.01; role-physical function: MD = 9.76, 95% CI = 6.05 to 13.47, p < 0.001; body pain: MD = 8.49, 95% CI = 1.18 to 15.8, p = 0.02; general health: MD = 9.80, 95% CI = 5.77 to 13.82, p < 0.001; vitality: MD = 6.70, 95% CI = 0.45 to 12.94, p = 0.04; social function: MD = 9.1, 95% CI = 4.75 to 13.45, p < 0.001; role-emotional function: MD = 7.88, 95% CI = 4.03 to 11.72, p < 0.001; mental health: MD = 5.62, 95% CI = 1.57 to 9.67, p = 0.006) and BMI (MD = −1.53, 95% CI = −2.71 to −0.36, p < 0.001) compared with control group (wait list; no intervention; usual care; sham exercise).ConclusionTai Chi could improve QoL and decrease BMI for patients with T2DM, more studies are needed to be conducted in accordance with suggestions mentioned in this review.

Download Full-text

A Systematic review on Pharmaceutical Diabetic Care Services in United Arab Emirates (UAE)

Current Diabetes Reviews ◽

10.2174/1573399817999201228210029 ◽

2020 ◽

Vol 17 ◽

Author(s):

Syed Wasif Gillani ◽

Khanda Kareem Kaka Khan ◽

Douaa Ladouani ◽

Nour Alaa Salama

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Type 2 Diabetes ◽

United Arab Emirates ◽

Care Services ◽

Related Quality ◽

Health Related ◽

The Impact

Objective:: The aim of this systematic review study is to evaluate the current services and pharmaceutical care practices for diabetic patients in UAE. Methods:: Systematic review coverage conforms to the guidelines of the PRISMA; the search was limited to primary research articles, which describe the term ‘’ pharmaceutical diabetes care services in UAE’’. The search strategy was developed in collaboration with a health database librarian and a predetermined protocol was developed in conjunction with the authors for search methods. Results:: The findings showed the affect on a prescription treatment system on disease prevention and health related quality of life in patients with type 2 diabetes in United Arab Emirates. Implementing a retrospective interventional health evaluation to evaluate existing health procedure and the impact of conventional treatment on type 2 diabetes treatment (T2DM). The findings of this interventional evaluation were largely favorable, and the viability of changing the existing clinical procedure was stressed. The individualized strategy has helped clinicians reach a great result of terms of glycemic and BP, as well as patient satisfaction. The need of more work to clarify the long-term effect of organized strategy in enhancing the consistency of T2DM treatment in the UAE. The findings also showed increase community pharmacy services may further change the opinions of patients on the level of care provided from such pharmacies. The patients’ quality of life would improve by drug treatment efficacy and pharmacist services to mitigate diabetes complications. The findings showed the effect on a prescription treatment system on disease prevention and health-related quality of life in patients with type 2 diabetes in the United Arab Emirates. Implementing a retrospective interventional health evaluation to evaluate existing health procedure and the impact of conventional treatment on type 2 diabetes treatment (T2DM). The findings of this interventional evaluation were largely favorable, and the viability of changing the existing clinical procedure was stressed. The individualized strategy has helped clinicians reach a great result of terms of glycemic and BP, as well as patient satisfaction. The need for more work to clarify the long-term effect of organized strategy in enhancing the consistency of T2DM treatment in the UAE. The findings also showed increase community pharmacy services may further change the opinions of patients on the level of care provided from such pharmacies. The patients’ quality of life would improve by drug treatment efficacy and pharmacist services to mitigate diabetes complications. Conclusion:: This systematic review reported beneficial pharmacist-led diabetic management services in UAE. Several care strategies also highlighted to improve service for type 2 diabetes mellitus patients.

Download Full-text