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Improving type 2 diabetes mellitus glycaemic control through lifestyle modification implementing diet intervention: a systematic review and meta-analysis

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Abstract

Purpose

Type 2 diabetes mellitus represents a significant health problem. Many studies have reported that intensive nutritional intervention by itself or in addition to medications is the best method to improve glycaemic control in type 2 diabetes mellitus. However, in clinical practice, dietary education is not implemented as an integral part in the management of type 2 diabetes mellitus. The purpose of this systematic review and meta-analysis is to analyse the scientific evidence concerning the role of nutritional intervention in the glycaemic control of type 2 diabetes mellitus.

Methods

We searched Pubmed, Scopus, Cochrane Library and Web of Science databases from inception till May 2019 for randomised controlled trials (RCTs) that include dietary interventions in the management of patients with type 2 diabetes mellitus.

Results

A total of 28 studies were included. Our results demonstrated that lifestyle interventions significantly lowered glycosylated haemoglobin (HbA1c) levels compared to the usual care for patients with type 2 diabetes mellitus, overall weighted mean difference, WMD = − 0.51 (− 0.67, − 0.35). Strategies combining individualized and group-based activities were the most effective, WMD = − 0.95 (− 1.24, − 0.66). Most of stratified analyses did not totally resolve heterogeneity, but improvement in HbA1c levels has been consistently observed.

Conclusions

The available evidence from RCTs shows that lifestyle intervention is more effective than the standard care regarding the glycaemic control of type 2 diabetic patients, particularly when there is a weight loss. It is time to translate this evidence to the primary health care practice. The protocol of the present systematic review was registered in PROSPERO, registration number CRD42018090469.

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Abbreviations

BMI:

Body mass index

HbA1c :

Glycosylated haemoglobin

RCTs:

Randomised clinical trials

WMD:

Weighted mean difference

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Acknowledgements

The first author would like to acknowledge support by the CIBER Epidemiología y Salud Pública (CIBERESP/CB06/02/1014). The authors especially thank the co-authors for their collaboration and effort in this systematic review and meta-analysis.

Funding

The research leading to these results has received funding from the CIBER Epidemiología y Salud Pública (CIBERESP/CB06/02/1014).

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Authors and Affiliations

  1. Department of Preventive Medicine and Public Health, University of Granada, Avenida de la Investigación, 11, 18016, Granada, Spain

    Laura García-Molina, Blanca Riquelme-Gallego, Naomi Cano-Ibáñez & Aurora Bueno-Cavanillas

  2. CIBER Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5, 28029, Madrid, Spain

    Laura García-Molina, Naomi Cano-Ibáñez & Aurora Bueno-Cavanillas

  3. Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, Hamilton, ON, Canada

    Anne-Mary Lewis-Mikhael

  4. High Institute of Pubic Health, Alexandria University, 165 El-Horreya Avenue – El-Ibrahimia, Alexandria, Egypt

    Anne-Mary Lewis-Mikhael

  5. Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Avenida de Madrid, 15, 18018, Granada, Spain

    Blanca Riquelme-Gallego

  6. Department of Molecular Biology and Biochemical Engineering, University Pablo de Olavide, Carretera de Utrera, Km 1, 41013, Seville, Spain

    María-Jesús Oliveras-López

  7. Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Servicio Andaluz de Salud/Universidad de Granada, Avenida de Madrid, 15, 18018, Granada, Spain

    Aurora Bueno-Cavanillas

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  1. Laura García-Molina
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  2. Anne-Mary Lewis-Mikhael
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  3. Blanca Riquelme-Gallego
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Correspondence to Laura García-Molina.

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García-Molina, L., Lewis-Mikhael, AM., Riquelme-Gallego, B. et al. Improving type 2 diabetes mellitus glycaemic control through lifestyle modification implementing diet intervention: a systematic review and meta-analysis. Eur J Nutr 59, 1313–1328 (2020). https://doi.org/10.1007/s00394-019-02147-6

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