Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50924 Cologne, Germany.
Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), 18618687 Botucatu, Brazil.
Int J Environ Res Public Health. 2022 Apr 2;19(7):4243. doi: 10.3390/ijerph19074243.
A central aspect to the management of type 2 Diabetes Mellitus (T2DM) and hypertension is promoting a healthy lifestyle, and nutritional therapy (NT) can support patients achieving glycemic control and blood pressure targets. This systematic review aimed to evaluate the effectiveness of NT in the management of patients with T2DM and/or hypertension in primary care. Primary outcomes were HbA1c, systolic blood pressure (SBP) and diastolic blood pressure (DBP). Thirty-nine studies were included, thirty on T2DM and nine on hypertension. With a moderate quality of evidence, educational/counseling programs and food replacement programs in primary care likely reduce HbA1c on patients with T2DM (mean difference (MD): -0.37, 95% CI: -0.57 to -0.17, 7437 patients, 27 studies; MD: -0.54, 95% CI: -0.75 to -0.32, 440 patients, 2 studies, respectively). Mediterranean diet for T2DM was accessed by one study, and no difference between the groups was found. Educational and counseling programs likely reduce DBP in patients with hypertension (MD: -1.79, 95% CI: -3.46, -0.12, 2840 patients, 9 studies, moderate quality of the evidence), but the effect in SBP was unclear due to risk of bias and imprecision. Nutritional therapy strategies (i.e., educational/counseling programs and food replacement programs) in primary care improved HbA1c in patients with T2DM and DBP in individuals with hypertension.
2 型糖尿病（T2DM）和高血压管理的一个核心方面是促进健康的生活方式，营养治疗（NT）可以支持患者实现血糖控制和血压目标。本系统评价旨在评估 NT 在初级保健中管理 T2DM 和/或高血压患者的有效性。主要结局是 HbA1c、收缩压（SBP）和舒张压（DBP）。共纳入 39 项研究，30 项针对 T2DM，9 项针对高血压。中等质量证据表明，初级保健中的教育/咨询计划和食物替代计划可能会降低 T2DM 患者的 HbA1c（平均差异（MD）：-0.37，95%CI：-0.57 至-0.17，7437 例患者，27 项研究；MD：-0.54，95%CI：-0.75 至-0.32，440 例患者，2 项研究）。一项研究评估了 T2DM 的地中海饮食，两组之间没有差异。教育和咨询计划可能会降低高血压患者的 DBP（MD：-1.79，95%CI：-3.46，-0.12，2840 例患者，9 项研究，证据质量为中等），但由于偏倚风险和不精确性，SBP 的效果尚不清楚。初级保健中的营养治疗策略（即教育/咨询计划和食物替代计划）改善了 T2DM 患者的 HbA1c 和高血压患者的 DBP。
