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Background <p>To assess and rank the comparative effects of different exact macronutrient compositions for type 2 diabetes management rather than examining single macronutrients or as a dietary pattern.</p> Methods <p>PubMed, Scopus, and Cochrane Library Central Register of Controlled Trials were searched. Randomized controlled trials were included. A random-effects network meta-analysis with a Bayesian framework was performed to calculate the mean difference (MD) and 95% credible intervals (CrIs). The certainty of evidence was rated using the GRADE approach.</p> Results <p>80 trials with 9232 patients with type 2 diabetes were included in the network meta-analysis. A very low-carbohydrate, high-protein, and calorie-restricted diet had the greatest effect on reducing HbA<sub>1c</sub> (range of mean difference: −&#xa0;1.0% to −&#xa0;1.79%), weight (range of mean difference: -5.83&#xa0;kg to -10.96&#xa0;kg), and FPG (range of mean difference: −&#xa0;2.20&#xa0;mmol/L to −&#xa0;2.88&#xa0;mmol/L) at 6-month follow-up, but at 12-month follow-up, the effect remained only for HbA<sub>1c</sub> (range of mean difference: −&#xa0;1.25% to −&#xa0;1.30%) and FPG (range of mean difference: −&#xa0;1.21&#xa0;mmol/L to −&#xa0;1.27&#xa0;mmol/L). For weight loss in 12-month follow-up, the low-carbohydrate, high-protein diet was probably the most effective approach (range of mean difference: −&#xa0;10.05&#xa0;kg to −&#xa0;14.52&#xa0;kg). The best dietary approach to reduce LDL at 6-month follow-up was a low carbohydrate, high protein, calorie-restricted diet (range of mean difference: −&#xa0;0.49&#xa0;mmol/L to −&#xa0;0.59&#xa0;mmol/L) and at 12-month follow-up, a moderate carbohydrate, standard protein, calorie-restricted diet was effective in reducing LDL (mean difference: −&#xa0;0.87&#xa0;mmol/L, 95%CrI −&#xa0;1.55 to −&#xa0;0.16).</p> Conclusions <p>A very low carbohydrate, high protein, calorie-restricted diet can be an effective dietary composition in managing diabetes, but milder dietary carbohydrate restriction for weight loss in the long-term, and improving lipid profiles is needed.</p>

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Comparative effects of different macronutrient compositions for type 2 diabetes management: a systematic review and network meta-analysis of randomized trials

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  • 发表日期：

    2025年4月8日

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  • Negin Badrooj,
  • Ahmad Jayedi,
  • Sakineh Shab-Bidar

摘要

Background

To assess and rank the comparative effects of different exact macronutrient compositions for type 2 diabetes management rather than examining single macronutrients or as a dietary pattern.

Methods

PubMed, Scopus, and Cochrane Library Central Register of Controlled Trials were searched. Randomized controlled trials were included. A random-effects network meta-analysis with a Bayesian framework was performed to calculate the mean difference (MD) and 95% credible intervals (CrIs). The certainty of evidence was rated using the GRADE approach.

Results

80 trials with 9232 patients with type 2 diabetes were included in the network meta-analysis. A very low-carbohydrate, high-protein, and calorie-restricted diet had the greatest effect on reducing HbA1c (range of mean difference: − 1.0% to − 1.79%), weight (range of mean difference: -5.83 kg to -10.96 kg), and FPG (range of mean difference: − 2.20 mmol/L to − 2.88 mmol/L) at 6-month follow-up, but at 12-month follow-up, the effect remained only for HbA1c (range of mean difference: − 1.25% to − 1.30%) and FPG (range of mean difference: − 1.21 mmol/L to − 1.27 mmol/L). For weight loss in 12-month follow-up, the low-carbohydrate, high-protein diet was probably the most effective approach (range of mean difference: − 10.05 kg to − 14.52 kg). The best dietary approach to reduce LDL at 6-month follow-up was a low carbohydrate, high protein, calorie-restricted diet (range of mean difference: − 0.49 mmol/L to − 0.59 mmol/L) and at 12-month follow-up, a moderate carbohydrate, standard protein, calorie-restricted diet was effective in reducing LDL (mean difference: − 0.87 mmol/L, 95%CrI − 1.55 to − 0.16).

Conclusions

A very low carbohydrate, high protein, calorie-restricted diet can be an effective dietary composition in managing diabetes, but milder dietary carbohydrate restriction for weight loss in the long-term, and improving lipid profiles is needed.