Low-carbohydrate diets and type 2 diabetes treatment: a meta-analysis of randomized controlled trials
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ORIGINAL ARTICLE
Low‑carbohydrate diets and type 2 diabetes treatment: a meta‑analysis of randomized controlled trials G. A. Silverii1 · L. Botarelli1 · I. Dicembrini1 · V. Girolamo1 · F. Santagiuliana2 · M. Monami2 · E. Mannucci1 Received: 27 February 2020 / Accepted: 27 June 2020 © Springer-Verlag Italia S.r.l., part of Springer Nature 2020
Abstract Aim To assess whether LC diets are associated with long-term improvement in glycemic control and weight loss in people with T2DM, and their cardiovascular and renal safety. Methods Meta-analysis of randomized controlled trials lasting more than 3 months, retrieved through extensive search on PubMed, Embase, ClinicalTrial.gov, Cochrane databases up to March 1st, comparing LC diets and balanced carbohydrate diets in people with T2DM. Results We retrieved 37 trials, including 3301 patients. Average carbohydrate intake in LC diets was 36% of total energy. LC diets were associated with significant reduction of HbA1c at 3 months (MD − 0.17%, 95% CI − 0.27, − 0.07), no difference at 6 and 12 months, and significant increase at 24 months (MD 0.23%, 95% CI MD 0.02, 0.44). VLC diets were associated with significant HbA1c reduction at 3 and 6 months (MD − 0.43% − 0.60, − 0.26%, and MD − 0.40% 95% CI − 0.59, − 0.22, respectively), but not at 12 and 24 months. LC diets were associated with significant BMI reduction at 6 months (− 1.35 kg/m2 95% CI, − 2.18, − 0.52), but not at other time points. Only a minority of trials reported data on renal function, so renal safety could not be assessed. No significant differences in body weight, lipid profile, or blood pressure were found in the long term. Conclusion LC diets may produce small short-term improvements in HbA1c and weight, which are not maintained in the long term. Data on their renal safety are insufficient. Keywords Meta-analysis · Type 2 diabetes mellitus · Low-carbohydrate diets
Introduction Nutritional therapy has a central role in the management of type 2 diabetes (T2DM). When delivered by an expert dietician, it induces a reduction of HbA1c [1], thus contributing to the achievement of glycemic targets; in addition, dietary approaches are crucial for the achievement of weight loss in overweight and obese patients. Obesity is known to affect around 32–50% of patients with T2DM in Continental Managed by Antonio Secchi. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00592-020-01568-8) contains supplementary material, which is available to authorized users. * G. A. Silverii [email protected] 1
Diabetology Unit, Florence University, Florence, Italy
Diabetology Unit, Careggi Hospital, Florence, Italy
2
Europe and around 65% of patients in UK and USA; up to 80% of people with T2DM worldwide are overweight [2]. In addition, eating habits affect the management of other risk factors often associated with diabetes and overweight, such as hypertension and dyslipidemia [3]. The optimal composition of diet for patients with T2DM has been debated for years.
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