Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: A systematic review and meta-analysis

Sainsbury, Emma; Kizirian, Nathalie; Partridge, Stephanie R.; Gill, Timothy; Colagiuri, Stephen; Gibson, Alice A.

doi:10.1016/j.diabres.2018.02.026

Cited by 214 publications

(226 citation statements)

References 56 publications

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“…Several reviews considering the binary options of low‐ or high‐carbohydrate diets have produced mixed results, probably as a result of methodological differences and poor dietary adherence in included trials . Recent meta‐analyses of low‐carbohydrate diets have consistently found a small but significant reduction in HbA 1c in the pooled effect at 6 months that was no longer present at 12 months, supporting the conclusions made in earlier reviews . Another recent review found modest reductions in HbA 1c were present at 12 months .…”

Section: Introductionmentioning

confidence: 71%

“…These studies were ≤6 months in duration, or only reported outcomes at 6 months, an important limitation to the clinical application of this finding. Earlier reviews found that reductions in HbA 1c or weight at 3 or 6 months were not maintained beyond 12 months . Adherence to the prescribed diets in this group was good and may be an important factor in the positive result seen in the meta‐analysis, but if this success cannot be replicated in longer trials or using even greater restrictions in carbohydrate, then this is an important limitation with implications for future research and clinical practice.…”

Section: Discussionmentioning

confidence: 88%

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Carbohydrate restriction for glycaemic control in Type 2 diabetes: a systematic review and meta‐analysis

et al. 2019

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Aim To conduct a systematic review and meta‐analysis to evaluate the effect of carbohydrate restriction on glycaemic control in Type 2 diabetes. Methods We searched Medline, EMBASE and CINAHL for the period between 1976 and April 2018. We included randomized controlled trials comparing carbohydrate restriction with a control diet which aimed to maintain or increase carbohydrate intake, and that reported HbA1c as an outcome and reported the amount of carbohydrate consumed during or at the end of the study, with outcomes reported at ≥3 months. Results We identified 1402 randomized controlled trials, 25 of which met the inclusion criteria, incorporating 2132 participants for the main outcome. Definitions of low carbohydrate varied among the studies. The pooled effect estimate from meta‐analysis was a weighted mean difference of –0.09% [95% CI –0.27, 0.08 (P = 0.30); I2 72% (P <0.001)], suggesting no effect on HbA1c of restricting the quantity of carbohydrate. A subgroup analysis of diets containing 50–130 g carbohydrate resulted in a pooled effect estimate of –0.49% [95% CI –0.75, –0.23 (P <0.001); I2 0% (P = 0.56)], suggesting a clinically and statistically significant effect on HbA1c in favour of low‐carbohydrate diets in studies of ≤6 months’ duration. Conclusions There was no overall pooled effect on HbA1c in favour of restricting carbohydrate; however, restriction of carbohydrate to 50–130 g per day had beneficial effects on HbA1c in trials up to 6 months. Future randomized controlled trials should be of >12 months’ duration, assess pre‐study carbohydrate intake, use recognized definitions of low‐carbohydrate diets and examine reasons for non‐adherence to prescribed diets in greater detail.

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Section: Introductionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 88%

Carbohydrate restriction for glycaemic control in Type 2 diabetes: a systematic review and meta‐analysis

et al. 2019

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“…Nine recent systematic reviews and meta‐analyses of the effects of carbohydrate restriction on HbA 1c considered in the present review consistently reported a short‐term improvement, maintained over 6–12 months, but which was not maintained over the longer term . Of the seven meta‐analyses, five reported statistically greater reductions in HbA 1c for restricted carbohydrate diets, but these were modest and typically in the order of 1–5 mmol/mol , with one reporting a reduction of 9 mmol/mol . Two systematic reviews reported equivocal results, with larger numbers of included trials failing to demonstrate superiority of low‐carbohydrate diets .…”

Section: Resultsmentioning

confidence: 99%

“…One systematic review attempted to address this issue by comparing studies in which there were no differences in weight loss between groups, but the authors were still unable to conclude that a particular balance of macronutrients or one dietary pattern was superior to any other . Only one of the meta‐analyses of low‐carbohydrate diets reported significant differences in weight between restricted‐ and higher‐carbohydrate diets, and it appeared that any short‐term improvements in glycaemic control were attributable solely to weight loss, with no significant differences between diets with equal weight loss .…”

Section: Resultsmentioning

confidence: 99%

“…These data suggest that carbohydrate restriction reduces HbA 1c more than control diets over the short term (6–12 months), but not the longer term, and reductions in medication are associated with carbohydrate restriction ; however, beyond the absolute amount of carbohydrate, or its percentage contribution to energy, are wider questions about dietary quality. Dietary patterns such as Mediterranean‐style diets and vegetarian and vegan diets have led to improvements in glycaemic control, weight loss and reduced CVD risk, despite providing moderate to high intakes of carbohydrate .…”

Section: Resultsmentioning

confidence: 99%

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James Lind Alliance research priorities: what role do carbohydrates, fats and proteins have in the management of Type 2 diabetes, and are there risks and benefits associated with particular approaches?

et al. 2018

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Aims To assess the role played by carbohydrates, fat and proteins in the management of Type 2 diabetes. Background Diabetes research tends to reflect the interests of academics or the pharmaceutical industry, rather than those of people living with Type 2 diabetes. The James Lind Alliance and Diabetes UK addressed this issue by defining the research priorities of people living with Type 2 diabetes. Three of the top 10 research priority questions focused on lifestyle. Methods A narrative review was undertaken with a structured search strategy using three databases. Search terms included the three macronutrients and Type 2 diabetes. No restrictions were placed on macronutrient quantity or length of study follow‐up. Outcomes included changes in HbA1c, body weight, insulin sensitivity and cardiovascular risk. Results There is no strong evidence that there is an optimal ratio of macronutrients for improving glycaemic control or reducing cardiovascular risk. Challenges included defining the independent effect of macronutrient manipulation and identifying the effects of macronutrients, independent of foods and dietary patterns. Extreme intakes of macronutrients may be associated with health risks. Conclusions It is challenging to formulate food‐based guidelines from studies based on macronutrient manipulation. Structured education should be offered to support individuals in discovering their optimal, individual dietary approach. Recommendations for dietary guidelines should be expressed in terms of foods and not macronutrients.

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Low-carbohydrate diet for people with type 2 diabetes mellitus

Burgos,

Ivaldi,

Oltra

et al. 2024

Cochrane Database of Systematic Reviews

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Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: A systematic review and meta-analysis

Cited by 214 publications

References 56 publications

Carbohydrate restriction for glycaemic control in Type 2 diabetes: a systematic review and meta‐analysis

Carbohydrate restriction for glycaemic control in Type 2 diabetes: a systematic review and meta‐analysis

James Lind Alliance research priorities: what role do carbohydrates, fats and proteins have in the management of Type 2 diabetes, and are there risks and benefits associated with particular approaches?

Low-carbohydrate diet for people with type 2 diabetes mellitus

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