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European Journal of Epidemiology
Published in: European Journal of Epidemiology 2/2018

Open Access 01-02-2018 | META-ANALYSIS

A network meta-analysis on the comparative efficacy of different dietary approaches on glycaemic control in patients with type 2 diabetes mellitus

Authors: Lukas Schwingshackl, Anna Chaimani, Georg Hoffmann, Carolina Schwedhelm, Heiner Boeing

Published in: European Journal of Epidemiology | Issue 2/2018

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Abstract

The aim of the present study is to assess the comparative efficacy of different dietary approaches on glycaemic control in patients with type 2 diabetes mellitus using a systematic review of the literature. Electronic and hand searches were performed until July 2017. The inclusion criteria were defined as follows: (1) randomized trial with a dietary approach; (2) adults with type 2 diabetes mellitus; (3) outcome either HbA1c (%) and/or fasting glucose (mmol/l); (4) minimum intervention period of 12 weeks. For each outcome measure, random effects network meta-analysis was performed in order to determine the pooled effect of each intervention relative to each of the other interventions. A total of 56 trials comparing nine dietary approaches (low-fat, Vegetarian, Mediterranean, high-protein, moderate-carbohydrate, low-carbohydrate, control, low GI/GL, Palaeolithic) enrolling 4937 participants were included. For reducing HbA1c, the low-carbohydrate diet was ranked as the best dietary approach (SUCRA: 84%), followed by the Mediterranean diet (80%) and Palaeolithic diet (76%) compared to a control diet. For reducing fasting glucose, the Mediterranean diet (88%) was ranked as the best approach, followed by Palaeolithic diet (71%) and Vegetarian diet (63%). The network analysis also revealed that all dietary approaches significantly reduce HbA1c (− 0.82 to − 0.47% reduction) and fasting glucose (− 1.61 to − 1.00 mmol/l reduction) compared to a control diet. According to the network meta-analysis the Mediterranean diet is the most effective and efficacious dietary approach to improve glycaemic control in type 2 diabetes patients.
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Literature
1.
WHO. Fact sheet no. 312: Diabetes. Geneva: WHO; 2013.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. www.​cochrane-handbook.​org. Accessed 10 May 2017.
36.
37.
38.
39.
StataCorp. Stata statistical software: release 14. College Station: StataCorp LP; 2015.
40.
White IR. Network meta-analysis. Stata J. 2015;15:951–85.
41.
Chaimani A, Salanti G. Visualizing assumptions and results in network meta-analysis: the network graphs package. Stata J. 2015;15:905–50.
42.
43.
Bucher HC, Guyatt GH, Griffith LE, Walter SD. The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol. 1997;50(6):683–91.PubMedCrossRef
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
Esposito K, Maiorino MI, Ciotola M, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Intern Med. 2009;151(5):306–14.PubMedCrossRef
56.
57.
58.
59.
60.
61.
62.
63.
Luger M, Holstein B, Schindler K, Kruschitz R, Ludvik B. Feasibility and efficacy of an isocaloric high-protein vs. standard diet on insulin requirement, body weight and metabolic parameters in patients with type 2 diabetes on insulin therapy. Exp Clin Endocrinol Diabetes. 2013;121(5):286–94. https://​doi.​org/​10.​1055/​s-0033-1341472.PubMedCrossRef
64.
Parker B, Noakes M, Luscombe N, Clifton P. Effect of a high-protein, high-monounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes. Diabetes Care. 2002;25(3):425–30.PubMedCrossRef
65.
66.
67.
68.
69.
70.
de Bont AJ, Baker IA, St Leger AS, et al. A randomised controlled trial of the effect of low fat diet advice on dietary response in insulin independent diabetic women. Diabetologia. 1981;21(6):529–33.PubMedCrossRef
71.
Heilbronn LK, Noakes M, Clifton PM. Effect of energy restriction, weight loss, and diet composition on plasma lipids and glucose in patients with type 2 diabetes. Diabetes Care. 1999;22(6):889–95.PubMedCrossRef
72.
Milne RM, Mann JI, Chisholm AW, Williams SM. Long-term comparison of three dietary prescriptions in the treatment of NIDDM. Diabetes Care. 1994;17(1):74–80.PubMedCrossRef
73.
74.
75.
76.
Walker KZ, O’Dea K, Nicholson GC, Muir JG. Dietary composition, body weight, and NIDDM. Comparison of high-fiber, high-carbohydrate, and modified-fat diets. Diabetes Care. 1995;18(3):401–3.PubMedCrossRef
77.
Wolever TM, Gibbs AL, Mehling C, et al. The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. Am J Clin Nutr. 2008;87(1):114–25.PubMedCrossRef
78.
Yamada Y, Uchida J, Izumi H, et al. A non-calorie-restricted low-carbohydrate diet is effective as an alternative therapy for patients with type 2 diabetes. Int Med. 2014;53(1):13–9.CrossRef
79.
Hockaday TD, Hockaday JM, Mann JI, Turner RC. Prospective comparison of modified fat-high-carbohydrate with standard low-carbohydrate dietary advice in the treatment of diabetes: one year follow-up study. Br J Nutr. 1978;39(2):357–62.PubMedCrossRef
80.
81.
82.
83.
84.
85.
86.
Stern L, Iqbal N, Seshadri P, et al. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med. 2004;140(10):778–85.PubMedCrossRef
87.
88.
89.
90.
91.
Kaplan RM, Hartwell SL, Wilson DK, Wallace JP. Effects of diet and exercise interventions on control and quality of life in non-insulin-dependent diabetes mellitus. J Gen Intern Med. 1987;2(4):220–8.PubMedCrossRef
92.
93.
Pritchard DA, Hyndman J, Taba F. Nutritional counselling in general practice: a cost effective analysis. J Epidemiol Community Health. 1999;53(5):311–6.PubMedPubMedCentralCrossRef
94.
Uusitupa M, Laitinen J, Siitonen O, Vanninen E, Pyorala K. The maintenance of improved metabolic control after intensified diet therapy in recent type 2 diabetes. Diabetes Res Clin Pract. 1993;19(3):227–38.PubMedCrossRef
95.
96.
Brand JC, Colagiuri S, Crossman S, Allen A, Roberts DC, Truswell AS. Low-glycemic index foods improve long-term glycemic control in NIDDM. Diabetes Care. 1991;14(2):95–101.PubMedCrossRef
97.
98.
99.
100.
101.
102.
103.
104.
105.
106.
107.
108.
109.
Brand-Miller J, Hayne S, Petocz P, Colagiuri S. Low-glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials. Diabetes Care. 2003;26(8):2261–7.PubMedCrossRef
110.
111.
112.
113.
114.
Liese AD, Roach AK, Sparks KC, Marquart L, D’Agostino RB Jr, Mayer-Davis EJ. Whole-grain intake and insulin sensitivity: the Insulin Resistance Atherosclerosis Study. Am J Clin Nutr. 2003;78(5):965–71.PubMedCrossRef
115.
Xiao JB, Hogger P. Dietary polyphenols and type 2 diabetes: current insights and future perspectives. Curr Med Chem. 2015;22(1):23–38.PubMedCrossRef
116.
117.
118.
119.
120.
121.
Lawes CM, Parag V, Bennett DA, et al. Blood glucose and risk of cardiovascular disease in the Asia Pacific region. Diabetes Care. 2004;27(12):2836–42.PubMedCrossRef
122.
Turner RC, Millns H, Neil HA, et al. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23). BMJ. 1998;316(7134):823–8.PubMedPubMedCentralCrossRef
123.
124.
Khaw KT, Wareham N, Bingham S, Luben R, Welch A, Day N. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med. 2004;141(6):413–20.PubMedCrossRef
Metadata
Title
A network meta-analysis on the comparative efficacy of different dietary approaches on glycaemic control in patients with type 2 diabetes mellitus
Authors
Lukas Schwingshackl
Anna Chaimani
Georg Hoffmann
Carolina Schwedhelm
Heiner Boeing
Publication date
01-02-2018
Publisher
Springer Netherlands
Published in
European Journal of Epidemiology / Issue 2/2018
Print ISSN: 0393-2990
Electronic ISSN: 1573-7284
DOI
https://doi.org/10.1007/s10654-017-0352-x

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