An evidence‐based approach to developing low‐carbohydrate diets for type 2 diabetes management: A systematic review of interventions and methods

2019 ◽  
Vol 21 (11) ◽  
pp. 2513-2525 ◽  
Author(s):  
Jessica Turton ◽  
Grant D. Brinkworth ◽  
Rowena Field ◽  
Helen Parker ◽  
Kieron Rooney
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Diabetes Management ◽  
Evidence Based ◽  
Low Carbohydrate

scholarly journals Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data

BMJ ◽  
2021 ◽  
pp. m4743
Author(s):  
Joshua Z Goldenberg ◽  
Andrew Day ◽  
Grant D Brinkworth ◽  
Junko Sato ◽  
Satoru Yamada ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Type 2 Diabetes ◽  
Weight Loss ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Low Carbohydrate ◽  
Remission Of Diabetes

Abstract Objective To determine the efficacy and safety of low carbohydrate diets (LCDs) and very low carbohydrate diets (VLCDs) for people with type 2 diabetes. Design Systematic review and meta-analysis. Data sources Searches of CENTRAL, Medline, Embase, CINAHL, CAB, and grey literature sources from inception to 25 August 2020. Study selection Randomized clinical trials evaluating LCDs (<130 g/day or <26% of a 2000 kcal/day diet) and VLCDs (<10% calories from carbohydrates) for at least 12 weeks in adults with type 2 diabetes were eligible. Data extraction Primary outcomes were remission of diabetes (HbA 1c <6.5% or fasting glucose <7.0 mmol/L, with or without the use of diabetes medication), weight loss, HbA 1c , fasting glucose, and adverse events. Secondary outcomes included health related quality of life and biochemical laboratory data. All articles and outcomes were independently screened, extracted, and assessed for risk of bias and GRADE certainty of evidence at six and 12 month follow-up. Risk estimates and 95% confidence intervals were calculated using random effects meta-analysis. Outcomes were assessed according to a priori determined minimal important differences to determine clinical importance, and heterogeneity was investigated on the basis of risk of bias and seven a priori subgroups. Any subgroup effects with a statistically significant test of interaction were subjected to a five point credibility checklist. Results Searches identified 14 759 citations yielding 23 trials (1357 participants), and 40.6% of outcomes were judged to be at low risk of bias. At six months, compared with control diets, LCDs achieved higher rates of diabetes remission (defined as HbA 1c <6.5%) (76/133 (57%) v 41/131 (31%); risk difference 0.32, 95% confidence interval 0.17 to 0.47; 8 studies, n=264, I 2 =58%). Conversely, smaller, non-significant effect sizes occurred when a remission definition of HbA 1c <6.5% without medication was used. Subgroup assessments determined as meeting credibility criteria indicated that remission with LCDs markedly decreased in studies that included patients using insulin. At 12 months, data on remission were sparse, ranging from a small effect to a trivial increased risk of diabetes. Large clinically important improvements were seen in weight loss, triglycerides, and insulin sensitivity at six months, which diminished at 12 months. On the basis of subgroup assessments deemed credible, VLCDs were less effective than less restrictive LCDs for weight loss at six months. However, this effect was explained by diet adherence. That is, among highly adherent patients on VLCDs, a clinically important reduction in weight was seen compared with studies with less adherent patients on VLCDs. Participants experienced no significant difference in quality of life at six months but did experience clinically important, but not statistically significant, worsening of quality of life and low density lipoprotein cholesterol at 12 months. Otherwise, no significant or clinically important between group differences were found in terms of adverse events or blood lipids at six and 12 months. Conclusions On the basis of moderate to low certainty evidence, patients adhering to an LCD for six months may experience remission of diabetes without adverse consequences. Limitations include continued debate around what constitutes remission of diabetes, as well as the efficacy, safety, and dietary satisfaction of longer term LCDs. Systematic review registration PROSPERO CRD42020161795.

scholarly journals Type 2 diabetes in women of reproductive age

2021 ◽  
Vol 9 (2) ◽  
Author(s):  
Donna M. Williams ◽  
Kathryn Evans Kreider
Keyword(s):  
Type 2 Diabetes ◽  
Nurse Practitioners ◽  
Diabetes Management ◽  
Reproductive Age ◽  
Current Evidence ◽  
Evidence Based ◽  
Women Of Reproductive Age

The prevalence of type 2 diabetes in women of reproductive age ranges from 3% to 7%. Due to the common nature of this condition, it is imperative for nurse practitioners who care for women to understand evidence-based methods of diabetes management. The aim of this article is to describe current screening and diagnostic criteria for type 2 diabetes, discuss current evidence-based management and patient education necessary to prevent long-term complications, and provide the tools for a healthy reproductive plan in women with type 2 diabetes from puberty until menopause. Diabetes management extends well beyond glucose control, and nurse practitioners should be attuned to all factors that can impact cardiovascular risk and quality of life.

scholarly journals Walking for subjects with type 2 diabetes: a systematic review and joint AMD/SID/SISMES evidence-based practical guideline

2020 ◽  
Author(s):  
P. Moghetti ◽  
◽  
S. Balducci ◽  
L. Guidetti ◽  
P. Mazzuca ◽  
...  
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Glucose Control ◽  
Well Being ◽  
Lifestyle Changes ◽  
Sufficient Evidence ◽  
Diabetic Patients ◽  
Evidence Based ◽  
Therapeutic Tool

Abstract Aims Regular exercise is considered a cornerstone in the management of type 2 diabetes mellitus (T2DM). It improves glucose control and cardiovascular risk factors, contributes to weight loss, and also improves general well-being, likely playing a role in the prevention of chronic complications of diabetes. However, compliance to exercise recommendations is generally inadequate in subjects with T2DM. Walking is the most ancestral form of physical activity in humans, easily applicable in daily life. It may represent, in many patients, a first simple step towards lifestyle changes. Nevertheless, while most diabetic patients do not engage in any weekly walking, exercise guidelines do not generally detail how to improve its use. The aims of this document are to conduct a systematic review of available literature on walking as a therapeutic tool for people with T2DM, and to provide practical, evidence-based clinical recommendations regarding its utilization in these subjects. Data synthesis Analysis of available RCTs proved that regular walking training, especially when supervised, improves glucose control in subjects with T2DM, with favorable effects also on cardiorespiratory fitness, body weight, and blood pressure. Moreover, some recent studies have shown that even short bouts of walking, used for breaking prolonged sitting, can ameliorate glucose profiles in diabetic patients with sedentary behavior. Conclusions There is sufficient evidence to recognize that walking is a useful therapeutic tool for people with T2DM. This document discusses theoretical and practical issues for improving its use.

scholarly journals Walking for subjects with type 2 diabetes: A systematic review and joint AMD/SID/SISMES evidence-based practical guideline

2020 ◽  
Vol 30 (11) ◽  
pp. 1882-1898 ◽  
Author(s):  
P. Moghetti ◽  
S. Balducci ◽  
L. Guidetti ◽  
P. Mazzuca ◽  
E. Rossi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Evidence Based ◽  
Practical Guideline
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