Low Glycemic Index/Load Dietary Patterns and Glycemia and Cardiometabolic Risk Factors in Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Bibliographic record
Abstract
Low-glycemic index (GI) and load (GL) dietary patterns are recommended for diabetes management by clinical practice guidelines globally. To inform the update of the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis on the effect of low-GI/GL dietary patterns on glycemic control and other established cardiometabolic risk factors in type 1 and 2 diabetes. MEDLINE, EMBASE, and the Cochrane Library were searched through November 2020. We included randomized controlled trials ≥3-weeks investigating the effect of low-GI/GL diets in diabetes. The primary outcome was HbA1c. Two independent reviewers extracted data and assessed risk of bias. GRADE (grading of recommendations assessment, development, and evaluation) assessed the certainty of the evidence. (ClinicalTrials.gov identifier, NCT04045938) We identified 30 trial comparisons in 1,672 participants with type 1 and 2 diabetes who were predominantly middle-aged, overweight or obese with moderately controlled type 2 diabetes treated by antihyperglycemic agents and/or insulin. Low-GI/GL dietary patterns significantly reduced HbA1c compared with higher-GI/GL control diets (mean difference −0.32% [95% confidence interval −0.48, −0.16%], P < 0.001; substantial heterogeneity, I2 = 74%, P < 0.001). There were also significant reductions in several secondary outcomes: fasting glucose, LDL-C, non-HDL-C, body weight, BMI, and CRP (P < 0.05), but not insulin or blood pressure. The certainty of evidence was moderate for the reduction in HbA1c and most secondary outcomes. Our synthesis indicates that low-GI/GL dietary patterns improve established targets of glycemic control, blood lipids, adiposity and inflammation beyond concurrent therapy with antihyperglycemic agents and/or insulin in moderately controlled type 1 and type 2 diabetes. The available evidence provides a good indication of the likely benefit in this population with moderate likelihood that more research will alter our conclusions. Diabetes and Nutrition Study Group of the EASD, CIHR.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.022 | 0.051 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.026 | 0.035 |
| Bibliometrics | 0.006 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".