ResearchReviewRestricted-Carbohydrate Diets in Patients with Type 2 Diabetes: A Meta-Analysis
Section snippets
Literature Search and Study Selection
We conducted a MEDLINE search in PubMed, Cumulative Index to Nursing and Allied Health, Combined Health Information Database, Cochrane Library, and Web of Science using Medical Subject Heading from 1980 through April 2006. We utilized the medical subject heading term diabetes mellitus, type 2 and combined it with the medical subject heading term, dietary carbohydrates. We retrieved abstracts of English-language studies in people aged 19 years of age and older, comparing restricted-carbohydrate
Results
Our search resulted in 329 articles; 56 contained information regarding carbohydrate content and type 2 diabetes (Figure 1). Thirteen published studies (Table 1) fulfilled our inclusion criteria (20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32). Some investigators published studies from the same data set, and the most comparable data set to other studies included in this meta-analysis was utilized (28, 29, 32, 33, 34, 35). A summary description of the designs for all 13 studies included in
Discussion
This meta-analysis indicates that lower-carbohydrate diets can be beneficial in treating type 2 diabetes, not only because of improved glycemic control, but also because of potential salutary changes in the lipid profile. Improvements in fasting glucose, HbA1c, and triglycerides appear to result from even moderate decreases in carbohydrate intake. For example, based on the meta-analysis regression model for triglycerides, a decrease in carbohydrate intake from 65% to 35% shows an expected
Summary
Diabetes mellitus is, in part, a disorder of carbohydrate metabolism that results in hyperglycemia. Carbohydrates are the component of the diet that exerts the greatest influence on postprandial blood glucose (41). Thus, it is logical that diets lower in carbohydrates would result in less hyperglycemia. Use of a balanced diet, exercise, and blood glucose−lowering medication should be combined to achieve glycemic control and a healthy weight. Results of our meta-analysis suggest short-term use
J. K. Kirk is an associate professor and D. E. Graves is a diabetes educator, Department of Family and Community Medicine, Wake Forest University School of Medicine, and T. E. Craven is a Biostatistician IV, Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC.
References (46)
- et al.
Effects of variation in protein and carbohydrate intake on body mass and composition during energy restriction: A meta-regression 1
Am J Clin Nutr
(2006) - et al.
Beneficial effect of low carbohydrate in low calorie diets on visceral fat reduction in type 2 diabetic patients with obesity
Diabetes Res Clin Pract
(2004) - et al.
An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes
Am J Clin Nutr
(2003) - et al.
Effects of a low-fat diet compared with those of a high-monounsaturated fat diet on body weight, plasma lipids and lipoproteins, and glycemic control in type 2 diabetes
Am J Clin Nutr
(2004) - et al.
Effect of high protein vs high carbohydrate intake on insulin sensitivity, body weight, hemoglobin A1c, and blood pressure in patients with type 2 diabetes mellitus
J Am Diet Assoc
(2005) - et al.
Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: A randomized trial
JAMA
(2005) - et al.
Weight management through lifestyle modification for the prevention and management of type 2 diabetes: Rationale and strategies: A statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition
Diabetes Care
(2004) - et al.
What are the long-term benefits of weight reducing diets in adults?A systematic review of randomized controlled trials
J Hum Nutr Diet
(2004) - et al.
Carbohydrate and fiber recommendations for individuals with diabetes: A quantitative assessment and meta-analysis of the evidence
J Am Coll Nutr
(2004) - et al.
Dietary advice for treatment of type 2 diabetes mellitus in adults
Cochrane Database Syst Rev
(2004)
The case for low carbohydrate diets in diabetes management
Nutr Metab
Nutrition in patients with type 2 diabetes: Are low-carbohydrate diets effective, safe or desirable?
Diabet Med
Efficacy and safety of low-carbohydrate diets: A systematic review
JAMA
Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: A meta-analysis of randomized controlled trials
Arch Intern Med
Dietary carbohydrate (amount and type) in the prevention and management of diabetes: A statement by the American Diabetes Association
Diabetes Care
Safety of low-carbohydrate diets
Obes Rev
Lasting improvement of hyperglycaemia and bodyweight: Low-carbohydrate diet in type 2 diabetesA brief report
Ups J Med Sci
Effect of a high-monounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes
Diabetes Care
Long-term effects of advise to consume a high-protein, low-fat diet rather than a conventional weight-loss diet, in obese adults with type 2 diabetes: A one year follow-up of a randomised trial
Diabetologia
SAS/STAT User’s Guide 9.1
Multilevel Models for Meta-Analysis
A random-effects regression model for meta-analysis
Stat Med
Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes
Diabetes
Cited by (147)
Modelling remission from overweight type 2 diabetes reveals how altering advice may counter relapse
2024, Mathematical BiosciencesObesity and Diabetes
2023, Industrial Application of Functional Foods, Ingredients and Nutraceuticals: Extraction, Processing and Formulation of Bioactive CompoundsDiabetes Canada Position Statement on Low-Carbohydrate Diets for Adults With Diabetes: A Rapid Review
2020, Canadian Journal of DiabetesConsuming a ketogenic diet leads to altered hypoglycemiccounter-regulation in mice
2020, Journal of Diabetes and its ComplicationsCitation Excerpt :Ketogenic diets (KD), very low carbohydrate diets which evoke nutritional ketosis, have been a popular weight loss strategy for decades.1 KDs are also becoming increasingly popular with diabetes patients2,3 and healthcare professionals,4,5 due to their efficacy in reducing HbA1c and body weight, as well as improving lipid profiles.6–8 However, KDs have been associated with increased frequency of hypoglycemia in T1DM9 and T2DM.7
J. K. Kirk is an associate professor and D. E. Graves is a diabetes educator, Department of Family and Community Medicine, Wake Forest University School of Medicine, and T. E. Craven is a Biostatistician IV, Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC.
E. W. Lipkin is an associate professor of Medicine, University of Washington, Seattle.
M. Austin is principal, The Austin Group, LLC, Shelby Township, MI.
K. L. Margolis is a senior clinical investigator, HealthPartners Research Foundation, Minneapolis, MN.