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High-Protein Diets for Treatment of Type 2 Diabetes Mellitus: A Systematic Review.

ABSTRACT: Diet has the potential to be a powerful and cost-effective tool for treatment of type 2 diabetes mellitus (T2D). High-protein diets have shown promise for this purpose. The objective of this systematic review was to evaluate whether high-protein diets improve glycemic outcomes in people with T2D. We conducted a systematic search of literature published prior to 1 February 2018 to find clinical studies of high-protein diet patterns for treatment of T2D in human participants. A high-protein diet was defined as a diet with protein content greater than that of a typical diet in the United States (>16% of total energy as protein). Studies were excluded if weight loss >5% occurred or if no glycemic outcomes were measured. A total of 21 independent articles met our criteria and were included. Most tested diets had a protein content of around 30% of total energy. Many studies supported the use of high-protein diets for patients with T2D, but were limited by small size (n = 8-32) and short duration (1-24 wk). Randomized controlled trials tended to be larger (n = 12-419) and longer (6 wk-2 y), and had mixed results, with many trials showing no difference between a high-protein diet and control. Many randomized controlled trials were limited by low compliance and high dropout rates >15%. There were no consistent beneficial or detrimental effects of high-protein diets on renal or cardiovascular outcomes. Evidence was insufficient to recommend 1 type of protein (plant or animal) over the other. Our review suggests that interventions to improve compliance with diet change over the long term may be equally important as specific macronutrient recommendations for treatment of T2D.

SUBMITTER: Malaeb S

PROVIDER: S-EPMC6628842 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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High-Protein Diets for Treatment of Type 2 Diabetes Mellitus: A Systematic Review.

Malaeb Samar S Bakker Caitlin C Chow Lisa S LS Bantle Anne E AE

Advances in nutrition (Bethesda, Md.) 20190701 4

Diet has the potential to be a powerful and cost-effective tool for treatment of type 2 diabetes mellitus (T2D). High-protein diets have shown promise for this purpose. The objective of this systematic review was to evaluate whether high-protein diets improve glycemic outcomes in people with T2D. We conducted a systematic search of literature published prior to 1 February 2018 to find clinical studies of high-protein diet patterns for treatment of T2D in human participants. A high-protein diet w ...[more]

PMID: 31305905

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Project description:AimsTo reduce the burden of type 2 diabetes (T2DM), the disease decision model plays a vital role in supporting decision-making. Currently, there is no comprehensive summary and assessment of the existing decision models for T2DM. The objective of this review is to provide an overview of the characteristics and capabilities of published decision models for T2DM. We also discuss which models are suitable for different study demands.Materials and methodsFour databases (PubMed, Web of Science, Embase, and the Cochrane Library) were electronically searched for papers published from inception to August 2020. Search terms were: "Diabetes-Mellitus, Type 2", "cost-utility", "quality-of-life", and "decision model". Reference lists of the included studies were manually searched. Two reviewers independently screened the titles and abstracts following the inclusion and exclusion criteria. If there was insufficient information to include or exclude a study, then a full-text version was sought. The extracted information included basic information, study details, population characteristics, basic modeling methodologies, model structure, and data inputs for the included applications, model outcomes, model validation, and uncertainty.ResultsFourteen unique decision models for T2DM were identified. Markov chains and risk equations were utilized by four and three models, respectively. Three models utilized both. Except for the Archimedes model, all other models (n = 13) implemented an annual cycle length. The time horizon of most models was flexible. Fourteen models had differences in the division of health states. Ten models emphasized macrovascular and microvascular complications. Six models included adverse events. Majority of the models (n = 11) were patient-level simulation models. Eleven models simulated annual changes in risk factors (body mass index, glycemia, HbA1c, blood pressure (systolic and/or diastolic), and lipids (total cholesterol and/or high-density lipoprotein)). All models reported the main data sources used to develop health states of complications. Most models (n = 11) could deal with the uncertainty of models, which were described in varying levels of detail in the primary studies. Eleven studies reported that one or more validation checks were performed.ConclusionsThe existing decision models for T2DM are heterogeneous in terms of the level of detail in the classification of health states. Thus, more attention should be focused on balancing the desired level of complexity against the required level of transparency in the development of T2DM decision models.

Project description:BACKGROUND:Type 2 diabetes mellitus (T2DM) is a major global health problem. As a complementary treatment, acupuncture and related techniques are widely used to treat metabolic and endocrine diseases, but their efficacy and safety for T2DM are yet to be established. This systematic review will qualitatively and quantitatively summarize the current randomized controlled trial (RCT) evidence regarding the efficacy and safety of acupuncture and related techniques in patients with T2DM. METHODS:Comprehensive literature searches will be performed on PubMed, Embase, Cochrane Central Register of Controlled Trials, and a trial registry "ClinicalTrials.gov" from inception to December 3, 2018. We will include RCTs for patients with T2DM that compared acupuncture with placebo, antidiabetic drugs, lifestyle interventions, or the combination. Primary outcomes are fasting blood glucose and hemoglobin A1c. Secondary outcomes include 2-hour blood glucose, fasting insulin, homeostatic model assessment for insulin resistance, incidence of diabetic complications, and acupuncture-related adverse events. The risk of bias of the RCTs included in the review will be examined using a revised Cochrane handbook tool. Heterogeneity will be detected using Cochran Q test and I statistics. With the use of random effects model, we will perform meta-analyses to pool results of RCTs. The effect measures will be weighted or standardized mean difference with 95% confidence intervals (CIs) for the continuous outcomes and risk ratio with 95% CIs for the dichotomous outcomes. Subgroup analyses and meta-regression with predefined effect modifiers will be performed to explore the sources of heterogeneity. Where appropriate, we will assess the possibility of reporting bias based on funnel plots and quantitative detection. We will appraise the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation system for each outcome. RESULTS:This study will provide accurate results and balanced inferences on the efficacy and safety of acupuncture and related techniques on T2DM. CONCLUSION:This well-designed systematic review will establish high-quality evidence of the efficacy and safety of acupuncture and related techniques for T2DM to facilitate the clinical practice and guideline development. PROSPERO REGISTRATION NUMBER:CRD42018115639.

Project description:IntroductionTo compare the efficacy of low-carbohydrate diets (LCDs) with low-fat diets (LFDs) in body weight and glycemic control for type 2 diabetes mellitus (T2DM) patients, and their cardiovascular and renal safety.MethodsWe searched PubMed, Ovid, Embase databases, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov from inception to April, 2021. Randomized controlled trials (RCTs) which lasted more than 3 months were included. The primary outcomes are the mean change from baseline in glycated haemoglobin (HbA1c) and body weight loss. Secondary outcomes included mean difference in lipid parameters, blood pressures, and serum creatinine.ResultsTotally, 12 RCTs met inclusion criteria representing 761 patients. Compared with LFDs, treatment with LCDs achieved significant reduced HbA1c by 0.35% (95% CI: -0.45, -0.24; P < 0.00001). LCDs appeared to be more beneficial in decreasing body weight than LFDs (WMD = -2.99 kg; 95% CI: -4.36, -1.63; P < 0.0001), especially in the subgroup that used VLCDs (WMD = -9.49 kg; 95% CI: -12.88, -6.09, P < 0.00001). For cardiovascular risk factors, the LCD interventions significantly reduced TG concentration (WMD: -0.20 mmol/l; 95% CI: -0.31, -0.10; P = 0.0001) and increased HDL-C concentration (WMD: 0.09 mmol/l; 95% CI: 0.05,0.13; P < 0.00001). Subgroup analyses demonstrated that the difference in HbA1c, TG, and HDL-C between two dietary restrictions respectively lasted up to 1.5 and 2 years, whereas the beneficial effects of body weight loss diminished over time and disappeared after 2 years. LCDs were not associated with decreased level of TC or LDL-C, neither SBP nor DBP in comparison with LFDs. Moreover, no significant difference in serum creatinine could be found among such two diet interventions.ConclusionsLCDs are superior to LFDs for T2DM patients in improving HbA1c and reducing body weight, with a rewarding effect of some cardiovascular risk factors in a longer-term diabetes management. However, available data are insufficient to evaluate the association between diet interventions and renal safety. Future larger longer-term follow-up clinical trials are needed to provide more evidence about the sustainable effects and safety of LCDs compared with LFDs.

Project description:OBJECTIVES:The primary objective of this systematic review was to evaluate available literature on whether type 1 diabetes mellitus (T1DM) has an impact on educational attainment in individuals undertaking high stakes standardised testing at the end of compulsory schooling. DESIGN:A systematic review was undertaken comparing educational attainment for individuals with and without T1DM who have undertaken high stakes testing at the end of compulsory schooling. DATA SOURCES:A comprehensive search of MEDLINE, MEDLINE (epub ahead of print, in-process and other non-indexed citations), EMBASE, Web of Science, British Education Index, Education Resources Information Center and Cumulative Index to Nursing and Allied Health Literature was undertaken on 15 January 2018 and updated on 17 January 2019. ELIGIBILITY CRITERIA:Included studies fulfilled the following criteria: observational study or randomised controlled trial; included individuals who have undertaken high stakes testing at the end of compulsory schooling; compared the grades obtained by individuals with T1DM with a representative population control. DATA EXTRACTION AND SYNTHESIS:Two reviewers performed study selection and data extraction independently. Quality and risk of bias in the observational studies included were assessed using the Newcastle-Ottawa Scale. A detailed narrative synthesis of the included studies was completed. RESULTS:3103 articles were identified from the database search, with two Swedish cohort studies (using the same linked administrative data) meeting final inclusion criteria. A small but statistically significant difference was reported in mean final grades, with children with T1DM found to have lower mean grades than their non-diabetic counterparts (adjusted mean difference 0.07-0.08). CONCLUSIONS:More contemporary research is required to evaluate the impact of T1DM in childhood on educational attainment in individuals undertaking high stakes standardised testing at the end of compulsory schooling, taking into consideration the substantial advances in management of T1DM in the last decade. PROSPERO REGISTRATION NUMBER:CRD42017084078.

Dataset Information

High-Protein Diets for Treatment of Type 2 Diabetes Mellitus: A Systematic Review.

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High-Protein Diets for Treatment of Type 2 Diabetes Mellitus: A Systematic Review.

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