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