Comparative efficacy of different eating patterns in the management of type 2 diabetes and prediabetes: An arm‐based Bayesian network meta‐analysis

Abstract

Aims/Introduction Diet therapy is a vital approach to manage type 2 diabetes and prediabetes. However, the comparative efficacy of different eating patterns is not clear enough. We aimed to compare the efficacy of various eating patterns for glycemic control, anthropometrics, and serum lipid profiles in the management of type 2 diabetes and prediabetes. Materials and Methods We conducted a network meta‐analysis using arm‐based Bayesian methods and random effect models, and drew the conclusions using the partially contextualized framework. We searched twelve databases and yielded 9,534 related references, where 107 studies were eligible, comprising 8,909 participants. Results Eleven diets were evaluated for 14 outcomes. Caloric restriction was ranked as the best pattern for weight loss (SUCRA 86.8%) and waist circumference (82.2%), low‐carbohydrate diets for body mass index (81.6%), and high‐density lipoprotein (84.0%), and low‐glycemic‐index diets for total cholesterol (87.5%) and low‐density lipoprotein (86.6%). Other interventions showed some superiorities, but were imprecise due to insufficient participants and needed further investigation. The attrition rates of interventions were similar. Meta‐regression suggested that macronutrients, energy intake, and weight may modify outcomes differently. The evidence was of moderate‐to‐low quality, and 38.2% of the evidence items met the minimal clinically important differences. Conclusions The selection and development of dietary strategies for diabetic/prediabetic patients should depend on their holistic conditions, i.e., serum lipid profiles, glucometabolic patterns, weight, and blood pressure. It is recommended to identify the most critical and urgent metabolic indicator to control for one specific patient, and then choose the most appropriate eating pattern accordingly.

Effect of Dietary Approaches on Glycemic Control in Patients with Type 2 Diabetes: A Systematic Review with Network Meta-Analysis of Randomized Trials

“…Although our study is not the first network meta-analysis to assess the comparative effects of different dietary approaches on glycemic control in T2DM patients, we made some further exploration. First, our research is the network meta-analysis with the largest number of dietary patterns compared [ 28 ]. Second, to explore the long-term effects of dietary approaches on glycemic control, we set the minimum study duration to 6 months, while other studies which focused on a similar objective, setting their criteria at 12 weeks [ 25 ] or no study length limitation [ 26 , 111 ].…”

“…To the best of our knowledge, to date, network meta-analyses simultaneously comparing the effects of different dietary approaches on glycemic control of T2DM patients are still scarce. No published systematic review and meta-analysis has included the controversial ketogenic diet in comparison with other dietary patterns [ 25 , 26 , 27 , 28 ]. Therefore, the present systematic review and network meta-analysis aimed to include some newly emerging and controversial diets, determine the relative effectiveness and certainty of evidence among dietary macronutrient patterns and popular food-based dietary approaches on glycemic control (HbA1c, fasting glucose) in T2DM patients through the synthesis of available evidence from randomized trials.…”

A Systematic Approach to Treating Early Metabolic Disease and Prediabetes

“…The food supply must be examined and addressed to enable healthy choices, without the economic burden of “organic” items which are also less accessible [ 64 – 66 ]. Through public health approaches to improve the food supply it may be possible to improve the metabolic health of whole populations by addressing excess (and empty) calories [ 67 ], insufficient vitamin D [ 68 ], insufficient dietary fiber [ 69 ], and insufficient healthy proteins [ 70 ].…”