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Table 2 Summary of findings for effects of carbohydrate-restricted diets in adults with type 2 diabetes mellitus

From: Effect of carbohydrate-restricted diets and intermittent fasting on obesity, type 2 diabetes mellitus, and hypertension management: consensus statement of the Korean Society for the Study of obesity, Korean Diabetes Association, and Korean Society of Hypertension

Outcome Illustrative comparative effecta (95% CI) No. of participants Quality of the evidence
(GRADE)
Assumed effect (control) Corresponding effect
mLCDb     
 HbA1c, % (follow-up: 8–24 weeks) −0.2 −0.21 (− 0.32 to − 0.10) 758 (10 studies)
Moderate
 HOMA-IR (follow-up: 8–24 weeks) − 0.4 –0.53 (− 0.96 to − 0.11) 248 (3 studies)
Low
 Fasting glucose, mg/dL (follow-up: 8–24 weeks) 4.65 −9.88 (−18.04 to − 1.71) 337 (6 studies)
Low
 Body weight, kg (follow-up: 8–24 weeks) −1.45 −1.54 (−3.11 to 0.02) 619 (8 studies)
Low
 Systolic blood pressure, mm Hg (follow-up: 8–24 weeks) −0.25 −2.99 (−5.48 to − 0.49) 510 (6 studies)
Moderate
 Diastolic blood pressure, mm Hg (follow-up: 8–24 weeks) 0.55 −1.07 (− 2.43 to 0.29) 513 (6 studies)
Low
 Triglyceride, mg/dL (follow-up: 8–24 weeks) −4.0 −17.22 (−34.27 to −0.18) 742 (10 studies)
Low
 LDL-C, mg/dL (follow-up: 8–24 weeks) −3.6 0.35 (−3.03 to 3.72) 607 (8 studies)
Low
 HDL-C, mg/dL (follow-up: 8–24 weeks) 0.2 2.30 (0.23 to 4.37) 547 (8 studies)
Moderate
 Hypoglycemia There is no study directly evaluated the risk of hypoglycemia. Patients at high risk of hypoglycemia were excluded in 2 out of 13 studies.
VLCDc     
 HbA1c, % (follow-up: 12–24 weeks) −0.2 −0.36 (− 0.54 to − 0.19) 321 (5 studies)
Moderate
 HOMA-IR (follow-up: 12–24 weeks) −0.45 −1.07 (−3.13 to 0.98) 119 (2 studies)
Low
 Fasting glucose, mg/dL (follow-up: 12–24 weeks) −17.2 −9.64 (− 19.54 to 0.26) 267 (3 studies)
Low
 Body weight, kg (follow-up: 12–24 weeks) −3.4 −3.84 (−7.55 to −0.13) 291 (4 studies)
Moderate
 Systolic blood pressure, mm Hg (follow-up: 12–24 weeks) −1.7 0.34 (−3.61 to 4.28) 218 (3 studies)
Low
 Diastolic blood pressure, mm Hg (follow-up: 12–24 weeks) −2.5 1.38 (−0.90 to 3.67) 218 (3 studies)
Low
 Triglyceride, mg/dL (follow-up: 12–24 weeks) −15.7 − 11.40 (− 27.01 to 4.22) 313 (5 studies)
Low
 LDL-C, mg/dL (follow-up: 12–24 weeks) − 1.35 7.19 (0.02 to 14.36) 277 (4 studies)
Moderate
 HDL-C, mg/dL (follow-up: 12–24 weeks) 2.3 0.43 (−1.98 to 2.84) 312 (5 studies)
Low
 Hypoglycemia Although no study directly evaluated the risk of hypoglycemia, patients at high risk of hypoglycemia were excluded in 4 out of 5 studies.
Intermittent fastingd     
 HbA1c, % (follow-up: 24 weeks) −0.6 0.10 (−0.35 to 0.55) 63 (1 study)
Low
 HbA1c, % (follow-up: 52 weeks) −0.5 0.20 (−0.22 to 0.62) 137 (1 study)
Low
 Body weight, kg (follow-up: 24 weeks) −4.0 −1.00 (−6.94 to 4.94) 63 (1 study)
Low
 Fat-free mass, kg (follow-up: 24 weeks) −1.1 −1.10 (−2.22 to 0.02) 49 (1 study)
Low
 Fat mass, kg (follow-up: 24 weeks) −4.0 0.20 (−1.46 to 1.86) 49 (1 study)
Low
 Fat mass, % (follow-up: 24 weeks) −2.1 0.40 (−0.86 to 1.66) 49 (1 study)
Low
 Hypoglycemia Although no study directly evaluated the risk of hypoglycemia, most studies in obese or overweight adults have excluded patients with diabetes as an exclusion criterion.
  1. aThe basis for the assumed effect is the mean change of outcomes compared to baseline in the control group across studies, and the corresponding effect (and its 95% CI) is based on the assumed effect in the comparison group
  2. bmLCD for type 2 diabetes mellitus: Patient or population (patients with type 2 diabetes mellitus), Intervention (mLCD)
  3. cVLCD for type 2 diabetes mellitus: Patient or population (patients with type 2 diabetes mellitus), Intervention (VLCD)
  4. dIntermittent fasting for type 2 diabetes mellitus: Patient or population (patients with type 2 diabetes mellitus), Intervention (intermittent fasting)
  5. CI confidence interval, GRADE Grading of Recommendations Assessment, Development and Evaluation, mLCD moderately-low carbohydrate or low carbohydrate diet, HbA1c glycosylated hemoglobin, HOMA-IR homeostatic model assessment for insulin resistance, LDL-C low-density lipoprotein cholesterol, HDL-C high-density lipoprotein cholesterol, VLCD very-low carbohydrate diet
  6. GRADE Working Group grades of evidence: High quality (Further research is very unlikely to change our confidence in the estimate of effect); Moderate quality (Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate); Low quality (Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate); Very low quality (We are very uncertain about the estimate).