Comparison of the Effectiveness of Low Carbohydrate Versus Low Fat Diets, in Type 2 Diabetes: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

The clinical benefit of low carbohydrate (LC) diets compared with low fat (LF) diets for people with type 2 diabetes (T2D) remains uncertain. We conducted a meta-analysis of randomized controlled trials (RCTs) to compare their efficacy and safety in people with T2D. RCTs comparing both diets in participants with T2D were identified from MEDLINE, Embase, Cochrane Library, and manual search of bibliographies. Mean differences and relative risks with 95% CIs were pooled for measures of glycaemia, cardiometabolic parameters, and adverse events using the following time points: short-term (3 months), intermediate term (6 and 12 months) and long-term (24 months). Twenty-two RCTs comprising 1391 mostly obese participants with T2D were included. At 3 months, a LC vs. LF diet significantly reduced HbA1c levels, mean difference (95% CI) of −0.41% (−0.62, −0.20). LC diet significantly reduced body weight, BMI, fasting insulin and triglycerides and increased total cholesterol and HDL-C levels at the short-to-intermediate term, with a decrease in the requirement for antiglycaemic medications at intermediate-to-long term. There were no significant differences in other parameters and adverse events. Except for reducing HbA1c levels and adiposity parameters at short-to-intermediate terms, a LC diet appears to be equally effective as a LF diet in terms of control of cardiometabolic markers and the risk of adverse events in obese patients with T2D.

Should carbohydrate‐modified diets be the first option for weight loss in people with impaired glucose metabolism? A scoping review

“…The finding that six of seven retrospective studies but only three of eight prospective studies support a phenotype by diet interaction needs to be interpreted carefully. First, findings from the vast majority of retrospective analyses agree with meta‐analytical findings that generally support a modest weight loss benefit for low‐CHO versus low‐fat diets 22–25 . Considering the physiologic plausibility of the Carbohydrate‐Insulin Model and known effects on insulin action on fat metabolism, it is not surprising that the potential benefit of a CHO‐modified diet would be observed and accentuated in people with impaired glucose metabolism.…”

“…Meta‐analytical evidence has consistently demonstrated that compared with low‐fat diets, low‐CHO diets produce marginally greater weight loss in the short‐ to intermediate‐term (i.e., ≤ 6 months), but that these differences are not often maintained with longer duration follow‐up. Importantly for the topic of this paper, the weight loss benefit of low‐CHO diets has been demonstrated in people with 22,23 and without T2D 24,25 and may suggest that greater short‐term weight loss may be achieved with a low‐CHO diet, irrespective of glycemic status. However, a growing body of literature—summarized in this review— has begun to address whether pretreatment glycemic and/or insulinemic status may moderate weight loss success with low‐CHO versus low‐fat diets.…”

“…First, findings from the vast majority of retrospective analyses agree with meta-analytical findings that generally support a modest weight loss benefit for low-CHO versus low-fat diets. [22][23][24][25] Considering the physiologic plausibility of the Carbohydrate-Insulin Model and known effects on insulin action on fat metabolism, it is not surprising that the potential benefit of a CHO-modified diet would be observed and accentuated in people with impaired glucose metabolism. However, the number of investigations that have specifically addressed this potential phenotype by diet interaction is comparatively limited.…”

Gut Microbiota in Patients with Prediabetes

“…A recent meta-analysis found that though in the short term (≤6 months) FMT improves fasting blood glucose, glycated hemoglobin, and plasma insulin levels, there are only slight long-term improvements (≥12 months) on glycated hemoglobin [ 15 ]. Diet alterations, on the other hand, have a long-term effect on the metabolic markers of diabetes [ 16 ].…”

Smart Solutions for Diet-Related Disease Management: Connected Care, Remote Health Monitoring Systems, and Integrated Insights for Advanced Evaluation

“…Early detection: timely identification and diagnosis of diseases enable healthcare providers to intervene early, potentially preventing complications and improving treatment outcomes [41,42]. • Treatment and care: disease management involves the provision of appropriate medical care, medications, therapies, and interventions tailored to the specific needs of individuals with chronic illnesses [43,44].…”