McArdle, Paul D. , Greenfield, Sheila M., Rilstone, Sian K. , Narendran, Parth , Haque, M. Sayeed and Gill, Paramjit (2019) Carbohydrate restriction for glycemic control in Type 2 diabetes : a systematic review and meta-analysis. Diabetic Medicine, 36 (3). pp. 335-348. doi:10.1111/dme.13862

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Abstract

Aim

To conduct a systematic review and meta‐analysis to evaluate the effect of carbohydrate restriction on glycaemic control in Type 2 diabetes.

Methods

We searched Medline, EMBASE and CINAHL for the period between 1976 and April 2018. We included randomized controlled trials comparing carbohydrate restriction with a control diet which aimed to maintain or increase carbohydrate intake, and that reported HbA1c as an outcome and reported the amount of carbohydrate consumed during or at the end of the study, with outcomes reported at ≥3 months.

Results

We identified 1402 randomized controlled trials, 25 of which met the inclusion criteria, incorporating 2132 participants for the main outcome. Definitions of low carbohydrate varied among the studies. The pooled effect estimate from meta‐analysis was a weighted mean difference of –0.09% [95% CI –0.27, 0.08 (P = 0.30); I2 72% (P <0.001)], suggesting no effect on HbA1c of restricting the quantity of carbohydrate. A subgroup analysis of diets containing 50–130 g carbohydrate resulted in a pooled effect estimate of –0.49% [95% CI –0.75, –0.23 (P <0.001); I2 0% (P = 0.56)], suggesting a clinically and statistically significant effect on HbA1c in favour of low‐carbohydrate diets in studies of ≤6 months’ duration.

Conclusions

There was no overall pooled effect on HbA1c in favour of restricting carbohydrate; however, restriction of carbohydrate to 50–130 g per day had beneficial effects on HbA1c in trials up to 6 months. Future randomized controlled trials should be of >12 months’ duration, assess pre‐study carbohydrate intake, use recognized definitions of low‐carbohydrate diets and examine reasons for non‐concordance in greater detail.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Non-insulin-dependent diabetes -- Treatment, Carbohydrates
Journal or Publication Title:	Diabetic Medicine
Publisher:	Blackwell
ISSN:	0742-3071
Official Date:	March 2019
Dates:	Date Event March 2019 Published 13 November 2018 Available 21 October 2018 Accepted
Volume:	36
Number:	3
Page Range:	pp. 335-348
DOI:	10.1111/dme.13862
Status:	Peer Reviewed
Publication Status:	Published
Reuse Statement (publisher, data, author rights):	"This is the peer reviewed version of the following article:McArdle, P. D., Greenfield, S. M., Rilstone, S. K., Narendran, P. , Haque, M. S. and Gill, P. S. (2018), Carbohydrate restriction for glycaemic control in Type 2 diabetes: a systematic review and meta‐analysis. Diabet. Med.. Accepted Author Manuscript. doi:10.1111/dme.13862, which has been published in final form at https://doi.org/10.1111/dme.13862. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions."
Access rights to Published version:	Restricted or Subscription Access
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID PROSPERO: CRD42015023586 [NIHR] National Institute for Health Research http://dx.doi.org/10.13039/501100000272
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