Faculty of Health Sciences, Department of Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
Division for Health Services, Norwegian Institute of Public Health, Oslo/Western Norway University of Applied Sciences, Centre for Evidence Based Practice, Bergen, Norway.
Diabetes Obes Metab. 2019 Jan;21(1):15-27. doi: 10.1111/dom.13499. Epub 2018 Sep 10.
This systematic review and meta-analysis (registration number: CRD42013005825) compares the effects of low carbohydrate diets (LCDs) on body weight, glycaemic control, lipid profile and blood pressure with the effects of higher carbohydrate diets (HCDs) in adults with type 2 diabetes.
MEDLINE, EMBASE, CENTRAL, CINAHL, Food Science Source and SweMed+ databases were systematically searched to identify randomized controlled trials (duration ≥3 months) investigating the effects of an LCD compared to an HCD in the management of type 2 diabetes. Data were extracted and pooled using a random effects model and were expressed as mean differences and risk ratio. Subgroup analyses were undertaken to examine the effects of duration of intervention, extent of carbohydrate restriction and risk of bias. The certainty of evidence was assessed using GRADE.
Of the 1589 studies identified, 23, including 2178 participants, met inclusion criteria. Reductions were slightly greater with LCDs than with HCDs for HbA1c (-1.0 mmol/mol; CI, -1.9, -0.1 [-0.09%; CI, -0.17, -0.01]) and for triglycerides (-0.13 mmol/L; CI, -0.24, -0.02). Changes in weight, HDL- and LDL-cholesterol, total cholesterol and blood pressure did not differ significantly between groups. Subgroup analyses suggested that the difference in HbA1c was evident only in studies with a duration of ≤6 months and with a high risk of bias.
The proportion of daily energy provided by carbohydrate intake is not an important determinant of response to dietary management, especially when considering longer term trials. A range of dietary patterns, including those traditional in Mediterranean countries, seems suitable for translating nutritional recommendations for individuals with diabetes into practical advice.
本系统评价和荟萃分析（注册号：CRD42013005825）比较了低碳水化合物饮食（LCDs）与高碳水化合物饮食（HCDs）对 2 型糖尿病成人的体重、血糖控制、血脂和血压的影响。
系统检索了 MEDLINE、EMBASE、CENTRAL、CINAHL、Food Science Source 和 SweMed+数据库，以确定比较 LCD 与 HCD 对 2 型糖尿病管理影响的随机对照试验（持续时间≥3 个月）。使用随机效应模型提取和汇总数据，并表示为均值差和风险比。进行亚组分析以检查干预持续时间、碳水化合物限制程度和偏倚风险的影响。使用 GRADE 评估证据的确定性。
在 1589 项研究中，有 23 项研究（包括 2178 名参与者）符合纳入标准。与 HCD 相比，LCD 组的 HbA1c（-1.0 mmol/mol；CI，-1.9，-0.1 [-0.09%；CI，-0.17，-0.01]）和甘油三酯（-0.13 mmol/L；CI，-0.24，-0.02）降低幅度略大。体重、HDL-和 LDL-胆固醇、总胆固醇和血压的变化在两组之间无显著差异。亚组分析表明，HbA1c 的差异仅在持续时间≤6 个月和高偏倚风险的研究中明显。
碳水化合物摄入量提供的每日能量比例不是对饮食管理反应的重要决定因素，尤其是考虑到长期试验时。一系列的饮食模式，包括地中海国家的传统饮食模式，似乎适合将针对糖尿病患者的营养建议转化为实际建议。
