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08-11-2021 | Diet | News

Meta-analysis supports benefits of low GI/GL diets in people with diabetes

Author: Claire Barnard

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medwireNews: Following a low glycemic index (GI) or glycemic load (GL) diet in addition to standard treatment is associated with improvements in glycemic control and other cardiometabolic risk factors in people with diabetes, suggest the results of a systematic review and meta-analysis.

“Our findings provide a comprehensive update on previous systematic reviews and meta-analyses,” and support “existing recommendations for the use of low GI/GL dietary patterns in the management of diabetes,” write the study authors in The BMJ.

The meta-analysis included 27 randomized controlled trials with a total of 1617 participants, the majority of whom were adults (93%) with type 2 diabetes (90%).

John Sievenpiper (University of Toronto, Ontario, Canada) and colleagues note that participants were predominantly middle-aged (median 56 years) and overweight or obese (median BMI=31 kg/m2), “with moderately controlled type 2 diabetes treated by hyperglycaemia drugs or insulin.”

Overall, people following low GI/GL diets experienced “small clinically significant reductions” in glycated hemoglobin (HbA1c) levels compared with those on control diets during a median follow-up of 12 weeks, with an average difference of 0.31%, say the researchers.

This reduction “would meet the threshold of ≥0.3% reduction in HbA1c proposed by the European Medicines Agency as clinically relevant for risk reduction of diabetic complications,” remark Sievenpiper et al.

They also found that low GI/GL diets were associated with a “moderate” and significant reduction in non-high-density lipoprotein cholesterol levels compared with control diets (mean reduction=0.20 mmol/L), as well as “small important” significant reductions in low-density lipoprotein cholesterol (0.17 mmol/L), triglycerides (0.09 mmol/L), bodyweight (0.66 kg), and BMI (0.38 kg/m2).

The team used GRADE methodology to assess the certainty of evidence in the included studies, finding that certainty “was high for the reduction in HbA1c and moderate for most secondary outcomes.”

In the safety analysis, low GI/GL diets were not associated with an increased risk for adverse events, and participants said they were preferred or equally acceptable to control diets.

“Our synthesis shows that low GI/GL dietary patterns are considered an acceptable and safe dietary strategy that can produce small meaningful reductions in the primary target for glycaemic control in diabetes, HbA1c, fasting glucose, and other established cardiometabolic risk factors,” summarize the researchers.

They continue: “As these benefits are seen beyond concurrent treatment with hyperglycaemia drugs or insulin, low GI/GL dietary patterns might be especially helpful as add-on treatment.”

Sievenpiper and colleagues recommend that larger randomized controlled trials should be carried out “[t]o confirm whether the improvements in intermediate cardiometabolic risk factors translate to reductions in clinical outcomes” such as cardiovascular disease, nephropathy, and retinopathy.

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

BMJ 2021; 374: n1651


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