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The Effect of Dietary Glycaemic Index on Glycaemia in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Nutrients 2018; 10(3)N

Abstract

BACKGROUND

The increasing prevalence of diabetes in the United Kingdom and worldwide calls for new approaches to its management, and diets with low glycaemic index have been proposed as a useful means for managing glucose response. However, there are conflicting reports and differences in the results of studies in terms of their effectiveness. Furthermore, the impact of low-glycaemic index diets and their long-term use in patients with type 2 diabetes remains unclear.

OBJECTIVES

The objective of this study was to conduct a systematic review and meta-analysis of the effect of low-glycaemic index diets in patients with type 2 diabetes.

METHODS

Search methods: Randomised controlled studies were selected from a number of databases (EBSCOHost with links to Health Research databases, PubMed, and grey literature) based on the Population, Intervention, Comparator, Outcomes and Study designs (PICOS) framework. The search terms included synonyms and Medical Subject Headings (MeSH) and involved the use of Boolean operators (AND/OR) which allowed the combination of words and search terms.

SELECTION CRITERIA

As per the selection criteria, the following types of articles were selected: studies on randomised controlled trials, with year of publication between 2008 and 2018, including patients with type 2 diabetes. Thus, studies involving patients with gestational and type 1 diabetes were excluded, as were observational studies. Nine articles which met the inclusion criteria were selected for the systematic review, whereas only six articles which met the criteria were included in the meta-analysis.

DATA COLLECTION AND ANALYSIS

Studies were evaluated for quality and risk of bias. In addition, heterogeneity, meta-analysis, and sensitivity tests of the extracted data were carried out using Review Manager 5.3 (Review Manager, 2014).

RESULTS

The findings of the systematic review showed that the low-glycaemic index (low-GI) diet resulted in a significant improvement (<0.05) in glycated haemoglobin (HbA1c) in two studies: low-GI diet Δ = -0.5% (95% CI, -0.61% to -0.39%) vs. high-cereal fibre diet Δ = -0.18% (95% CI, -0.29% to -0.07%); and low-GI legume diet Δ = -0.5% (95%, -0.6% to -0.4%) vs. high-wheat fibre diet Δ = -0.3% (95% Cl, -0.4 to -0.2%). There was a slight improvement in one study (low glycaemic response = 6.5% (6.3-7.1) vs. control = 6.6% (6.3-7.0) and no significant difference (p > 0.05) in four studies compared with the control diet. Four studies showed improvements in fasting blood glucose in low-GI diets compared to higher-GI diets or control: low-GI diet = 150.8 ± 8.7 vs. higher-GI diet = 157.8 ± 10.4 mg/dL, mean ± SD p = 0.43; low-GI diet = 127.7 vs. high-cereal fibre diet = 136.8 mg/dL, p = 0.02; low-GI diet = 6.5 (5.6-8.4) vs. standard diabetic diet = 6.7 (6.1-7.5) mmol/L, median and interquartile range p > 0.05; and low-GI diet = 7.3 ± 0.3 vs. conventional carbohydrate exchange diet = 7.7 ± 0.4 mmol/L, mean ± SEM (Standard Error of Mean) p < 0.05. The results of the meta-analysis and sensitivity tests demonstrated significant differences (p < 0.001 and p < 0.001, respectively) between the low-GI diet and the higher-GI diet or control diet in relation to glycated haemoglobin. Differences between the low-GI diet and higher-GI diet or control were significant (p < 0.05) with respect to the fasting blood glucose following meta-analysis.

CONCLUSION

The low-GI diet is more effective in controlling glycated haemoglobin and fasting blood glucose compared with a higher-GI diet or control in patients with type 2 diabetes.

Authors+Show Affiliations

Department of Adult Nursing and Paramedic Science, University of Greenwich, London SE9 2UG, UK. o.ojo@greenwich.ac.uk.Healthcare, Care UK, HMP Wormwood Scrubs, London W12 0AE, UK. Osarhumwese.Ojo@careuk.com.Department of Animal Production and Health, Federal University of Technology, PMB, Akure 704, Ondo State, Nigeria. debofajemisin@yahoo.co.uk.The School of Nursing, Soochow University, Suzhou 215006, China. wangxiaohua@suda.edu.cn.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

29562676

Citation

Ojo, Omorogieva, et al. "The Effect of Dietary Glycaemic Index On Glycaemia in Patients With Type 2 Diabetes: a Systematic Review and Meta-Analysis of Randomized Controlled Trials." Nutrients, vol. 10, no. 3, 2018.
Ojo O, Ojo OO, Adebowale F, et al. The Effect of Dietary Glycaemic Index on Glycaemia in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2018;10(3).
Ojo, O., Ojo, O. O., Adebowale, F., & Wang, X. H. (2018). The Effect of Dietary Glycaemic Index on Glycaemia in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients, 10(3), doi:10.3390/nu10030373.
Ojo O, et al. The Effect of Dietary Glycaemic Index On Glycaemia in Patients With Type 2 Diabetes: a Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2018 Mar 19;10(3) PubMed PMID: 29562676.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Effect of Dietary Glycaemic Index on Glycaemia in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. AU - Ojo,Omorogieva, AU - Ojo,Osarhumwese Osaretin, AU - Adebowale,Fajemisin, AU - Wang,Xiao-Hua, Y1 - 2018/03/19/ PY - 2018/01/31/received PY - 2018/03/07/revised PY - 2018/03/15/accepted PY - 2018/3/23/entrez PY - 2018/3/23/pubmed PY - 2018/9/18/medline KW - fasting blood glucose KW - glycaemic index KW - glycated haemoglobin KW - meta-analysis KW - randomised controlled trials KW - systematic review KW - type 2 diabetes JF - Nutrients JO - Nutrients VL - 10 IS - 3 N2 - BACKGROUND: The increasing prevalence of diabetes in the United Kingdom and worldwide calls for new approaches to its management, and diets with low glycaemic index have been proposed as a useful means for managing glucose response. However, there are conflicting reports and differences in the results of studies in terms of their effectiveness. Furthermore, the impact of low-glycaemic index diets and their long-term use in patients with type 2 diabetes remains unclear. OBJECTIVES: The objective of this study was to conduct a systematic review and meta-analysis of the effect of low-glycaemic index diets in patients with type 2 diabetes. METHODS: Search methods: Randomised controlled studies were selected from a number of databases (EBSCOHost with links to Health Research databases, PubMed, and grey literature) based on the Population, Intervention, Comparator, Outcomes and Study designs (PICOS) framework. The search terms included synonyms and Medical Subject Headings (MeSH) and involved the use of Boolean operators (AND/OR) which allowed the combination of words and search terms. SELECTION CRITERIA: As per the selection criteria, the following types of articles were selected: studies on randomised controlled trials, with year of publication between 2008 and 2018, including patients with type 2 diabetes. Thus, studies involving patients with gestational and type 1 diabetes were excluded, as were observational studies. Nine articles which met the inclusion criteria were selected for the systematic review, whereas only six articles which met the criteria were included in the meta-analysis. DATA COLLECTION AND ANALYSIS: Studies were evaluated for quality and risk of bias. In addition, heterogeneity, meta-analysis, and sensitivity tests of the extracted data were carried out using Review Manager 5.3 (Review Manager, 2014). RESULTS: The findings of the systematic review showed that the low-glycaemic index (low-GI) diet resulted in a significant improvement (<0.05) in glycated haemoglobin (HbA1c) in two studies: low-GI diet Δ = -0.5% (95% CI, -0.61% to -0.39%) vs. high-cereal fibre diet Δ = -0.18% (95% CI, -0.29% to -0.07%); and low-GI legume diet Δ = -0.5% (95%, -0.6% to -0.4%) vs. high-wheat fibre diet Δ = -0.3% (95% Cl, -0.4 to -0.2%). There was a slight improvement in one study (low glycaemic response = 6.5% (6.3-7.1) vs. control = 6.6% (6.3-7.0) and no significant difference (p > 0.05) in four studies compared with the control diet. Four studies showed improvements in fasting blood glucose in low-GI diets compared to higher-GI diets or control: low-GI diet = 150.8 ± 8.7 vs. higher-GI diet = 157.8 ± 10.4 mg/dL, mean ± SD p = 0.43; low-GI diet = 127.7 vs. high-cereal fibre diet = 136.8 mg/dL, p = 0.02; low-GI diet = 6.5 (5.6-8.4) vs. standard diabetic diet = 6.7 (6.1-7.5) mmol/L, median and interquartile range p > 0.05; and low-GI diet = 7.3 ± 0.3 vs. conventional carbohydrate exchange diet = 7.7 ± 0.4 mmol/L, mean ± SEM (Standard Error of Mean) p < 0.05. The results of the meta-analysis and sensitivity tests demonstrated significant differences (p < 0.001 and p < 0.001, respectively) between the low-GI diet and the higher-GI diet or control diet in relation to glycated haemoglobin. Differences between the low-GI diet and higher-GI diet or control were significant (p < 0.05) with respect to the fasting blood glucose following meta-analysis. CONCLUSION: The low-GI diet is more effective in controlling glycated haemoglobin and fasting blood glucose compared with a higher-GI diet or control in patients with type 2 diabetes. SN - 2072-6643 UR - https://www.unboundmedicine.com/medline/citation/29562676/The_Effect_of_Dietary_Glycaemic_Index_on_Glycaemia_in_Patients_with_Type_2_Diabetes:_A_Systematic_Review_and_Meta_Analysis_of_Randomized_Controlled_Trials_ L2 - http://www.mdpi.com/resolver?pii=nu10030373 DB - PRIME DP - Unbound Medicine ER -