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Meta-Analysis
. 2009 Jan 21;2009(1):CD006296.
doi: 10.1002/14651858.CD006296.pub2.

Low glycaemic index, or low glycaemic load, diets for diabetes mellitus

Diana Thomas  1 , Elizabeth J Elliott
Affiliations
Meta-Analysis

Low glycaemic index, or low glycaemic load, diets for diabetes mellitus

Diana Thomas et al. Cochrane Database Syst Rev. .

Abstract

Background: The aim of diabetes management is to normalise blood glucose levels, since improved blood glucose control is associated with reduction in development, and progression, of complications. Nutritional factors affect blood glucose levels, however there is currently no universal approach to the optimal dietary treatment for diabetes. There is controversy about how useful the glycaemic index (GI) is in diabetic meal planning. Improved glycaemic control through diet could minimise medications, lessen risk of diabetic complications, improve quality of life and increase life expectancy.

Objectives: To assess the effects of low glycaemic index, or low glycaemic load, diets on glycaemic control in people with diabetes.

Search strategy: We performed electronic searches of The Cochrane Library, MEDLINE, EMBASE and CINAHL with no language restriction.

Selection criteria: We assessed randomised controlled trials of four weeks or longer that compared a low glycaemic index, or low glycaemic load, diet with a higher glycaemic index, or load, or other diet for people with either type 1 or 2 diabetes mellitus, whose diabetes was not already optimally controlled.

Data collection and analysis: Two reviewers independently extracted data on study population, intervention and outcomes for each included study, using standardised data extraction forms.

Main results: Eleven relevant randomised controlled trials involving 402 participants were identified. There was a significant decrease in the glycated haemoglobin A1c (HbA1c) parallel group of trials, the weighted mean difference (WMD) was -0.5% with a 95% confidence interval (CI) of - 0.9 to -0.1, P = 0.02; and in the cross-over group of trials the WMD was -0.5% with a 95% CI of -1.0 to -0.1, P = 0.03. Episodes of hypoglycaemia were significantly fewer with low compared to high GI diet in one trial (difference of -0.8 episodes per patient per month, P < 0.01), and proportion of participants reporting more than 15 hyperglycaemic episodes per month was lower for low-GI diet compared to measured carbohydrate exchange diet in another study (35% versus 66%, P = 0.006). No study reported on mortality, morbidity or costs.

Authors' conclusions: A low-GI diet can improve glycaemic control in diabetes without compromising hypoglycaemic events.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Adapted QUOROM (quality of reporting of meta‐analyses) flow‐chart of study selection
1.1
1.1. Analysis
Comparison 1 Low glycaemic index or low glycaemic load diet versus other diet, Outcome 1 Glycated haemoglobin (%HbA1c).
1.2
1.2. Analysis
Comparison 1 Low glycaemic index or low glycaemic load diet versus other diet, Outcome 2 Fructosamine (mMol/L).
See this image and copyright information in PMC

Comment in

References

References to studies included in this review

Brand 1991 {published data only}
    1. Brand JC, Colagiuri S, Crossman S, Allen A, Roberts DC, Truswell AS. Low‐glycemic index foods improve long‐term glycemic control in NIDDM. Diabetes Care 1991;14(2):95‐101. - PubMed
Collier 1988 {published data only}
    1. Collier GR, Giudici S, Kalmusky J, Wolever TM, Helman G, Wesson V, Ehrlich RM Jenkins DJ. Low glycemic index starchy foods improve glucose control and lower serum cholesterol in diabetic children. Diabetes Nutrition and Metabolism 1988;1:11‐19.
Fontvieille 1992 {published data only}
    1. Fontvieille AM, Rizkalla SW, Penfornis A, Acosta M, Bornet FR, Slama G. The use of low glycaemic index foods improves metabolic control of diabetic patients over five weeks. Diabetic Medicine 1992;9:444‐50. - PubMed
Frost 1994 {published data only}
    1. Frost G, Wilding J, Beecham J. Dietary advice based on the glycaemic index improves dietary profile and metabolic control in type 2 diabetic patients. Diabetic Medicine 1994;11:397‐40. - PubMed
Giacco 2000 {published data only}
    1. Giacco R, Parillo M, Rivellese A, Lasorella G, Giacco A, D'Episcopo L, Riccardi G. Long‐term dietary treatment with increased amounts of fiber‐rich low‐glycemic index natural foods improves blood glucose control and reduces the number of hypoglycemic events in type 1 diabetic patients. Diabetes Care 2000;23:1461‐6. - PubMed
Gilbertson 2001 {published data only}
    1. Gilbertson H, Brand‐Miller J, Thorburn A, Evans S, Chondros P, Werther G. The effect of flexible low glycemic index dietary advice versus measured carbohydrate exchange diets on glycemic control in children with type 1 diabetes. Diabetes Care 2001;24:1137‐43. - PubMed
Jimenez‐Cruz 2003 {published data only}
    1. Jimenez‐Cruz A, Bacardi‐Gascon M, Turnbull WH, Rosales‐Garay P, Severino‐Lugo I. A Flexible, Low‐Glycemic Index Mexican‐Style Diet in Overweight and Obese Subjects With Type 2 Diabetes Improves Metabolic Parameters During a 6‐Week Treatment Period. Diabetes Care 2003;26:1967‐70. - PubMed
Komindr 2001 {published data only}
    1. Komindr S, Ingsriswang S, Lerdvuthisopon N, Boontawee A. Effect of long‐term intake of Asian food with different glycemic indices on diabetic control and protein conservation in type 2 diabetic patients. Journal of the Medical Association of Thailand 2001;84:85‐97. - PubMed
Luscombe 1999 {published data only}
    1. Luscombe ND, Noakes M, Clifton PM. Diets high and low in glycemic index versus high monounsaturated fat diets: effects on glucose and lipid metabolism in NIDDM. European Journal of Clinical Nutrition 1999;53:473‐8. - PubMed
Rizkalla 2004 {published data only}
    1. Rizkalla SW, Taghrid L, Laromiguiere M, Huet D, Boillot J, Rigoir A, Elgrably F, Slama. Improved Plasma Glucose Control, Whole‐Body Glucose Utilization, and Lipid Profile on a Low‐Glycemic Index Diet in Type 2 Diabetic Men: A randomized controlled trial. Diabetes Care 2004;27:1866‐72. - PubMed
Wolever 1992 {published data only}
    1. Wolever TM, Jenkins DJ, Vuksan V, Jenkins AL, Wong GS, Josse RG. Beneficial effect of low‐glycemic index diet in overweight NIDDM subjects. Diabetes Care 1992;15:562‐4. - PubMed

References to studies excluded from this review

Heilbronn 2002 {published data only}
    1. Heilbronn LK, Noakes M, Clifton PM. The Effect of High‐ and Low‐Glycemic Index Energy Restricted Diets on Plasma Lipid and Glucose Profiles in Type 2 Diabetic Subjects with Varying Glycemic Control. Journal of the American College of Nutrition 2002;21:120‐7. - PubMed
Jarvi 1999 {published data only}
    1. Jarvi A, Karlstrom B, Granfeldt Y, Bjorck I, Asp N, Vessby B 1999. Improved glycemic control and lipid profile and normalized fibrinolytic activity on a low‐glycemic index diet in type 2 diabetic patients. Diabetes Care 1999;22:10‐8. - PubMed
Jenkins 1988 {published data only}
    1. Jenkins DJ, Wolever TM, Buckley G, Lam KY, Giudici S, Kalmusky J, Jenkins AL, Patten RL, Bird J, Wong GS. Low‐glycemic‐index starchy foods in the diabetic diet. American Journal of Clinical Nutrition 1988;48:248‐54. - PubMed
Lafrance 1998 {published data only}
    1. Lafrance L, Rabasa‐Lhoret R, Poisson D, Ducros F, Chiasson JL. Effects of different glycaemic index foods and dietary fibre intake on glycaemic control in type 1 diabetic patients on intensive insulin therapy. Diabetic Medicine 1998;15(11):972‐8. - PubMed
Ma 2008 {published data only}
    1. Ma Y, Olendzki BC, Merriam PA, Chiriboga DE, Culver AL, et al. A randomized clinical trial comparing low‐glycemic index versus ADA dietary education among individuals with type 2 diabetes. Nutrition 2007;24:45‐56. - PMC - PubMed
Wolever 1992 b {published data only}
    1. Wolever TMS, Jenkins DJA, Vuskan V, Jenkins AL, Buckley GC, Wong GS, Josse RG. Beneficial effect of a low glycaemic index diet in type 2 diabetes. Diabetic Medicine 1992;9:451‐8. - PubMed
Wolever 2008 {published data only}
    1. Wolever TMS, Gibbs AL, Mehling C, Chiasson JL, Connelly PW, Josse RG, et al. The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1‐y controlled trial of low‐glycemic‐index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C‐reactive protein. American Journal of Clinical Nutrition 2008;87:114‐25. - PubMed

Additional references

ADA 2004
    1. Goldstein DE, Little RR, Lorenz RA, Malone JI, Nathan DM, Peterson CM. Tests of Glycemia in Diabetes. Diabetes Care 2004;27(1 Suppl):S91‐3. - PubMed
ADA 2008
    1. American Diabetes Association. Nutrition recommendations and interventions for diabetes. Diabetes Care 2008;31:S61‐78. - PubMed
Brand‐Miller 2003
    1. Brand‐Miller J, Hayne S, Petocz P, Colagiuri S. Low‐Glycemic Index Diets in the Management of Diabetes. Diabetes Care 2003;26(8):2261‐7. - PubMed
Cohen 1960
    1. Cohen J. A coefficient of agreement for nominal scales. Educational and Psychological Measurement. 37‐46, 1960.
Cooper 1994
    1. Cooper H, Hedges LV. The handbook of research synthesis. NewYork: Russell Safe Foundation, 1994.
Crapo 1977
    1. Crapo PA, Reaven G, Olefsky J Crapo PA, Reaven G, Olefsky J. Postprandial plasma‐glucose and ‐insulin responses to different complex carbohydrates. Diabetes 1977;26:1178‐83. - PubMed
Fleiss 1981
    1. Fleiss. Statistical Methods for Rates and Proportions. 2nd Edition. Wiley, New York, 1981.
Franz 2004
    1. Bantle JP, Beebe C, Brunzell JD, Chiasson JL, Garg A, Franz MJ, et al. Nutrition principles and recommendations in diabetes. Diabetes Care 2004;27(1 Suppl):S36‐46. - PubMed
Goldstein 1995
    1. Goldstein DE, Little RR, Lorenz RA, Malone JI, Nathan DM, Peterson CM. Tests of glycemia in diabetes (Technical Review). Diabetes Care 1995;18:896‐909. - PubMed
Higgins 2002
    1. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Statistics in medicine 2002;21:1539‐58. - PubMed
Higgins 2003
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analysis. BMJ 2003;327:557‐60. - PMC - PubMed
Higgins 2005
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.5 [updated May 2005]. In: The Cochrane Library, Issue 3, 2005. Chichester, UK: John Wiley & Sons, Ltd.
Holman 1999
    1. Holman RR, Cull CA, Turner RC. A Randomized Double‐Blind Trial of Acarbose in Type 2 Diabetes Shows Improved Glycemic Control Over 3 Years (U.K. Prospective Diabetes Study 44). Diabetes Care 1999;22:960‐4. - PubMed
Jadad 1996
    1. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Controlled Clinical Trials 1996;17:1‐12. - PubMed
Jenkins 1981
    1. Jenkins DJ, Wolever TM, Taylor RH, Barker H, Fielden H, Baldwin JM, et al. Glycemic index of foods: a physiological basis for carbohydrate exchange. American Journal of Clinical Nutrition 1981;34(3):362‐6. - PubMed
Moher 1999
    1. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta‐analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta‐analyses. Lancet 1999;354(9193):1896‐900. - PubMed
Nield 2008
    1. Nield L, Moore HJ, Hooper L, Cruickshank JK, Vyas A, Whittaker V, Summerbell CD. Dietary advice for treatment of type 2 diabetes mellitus in adults (Review). Cochrane Database of Systematic Reviews 2007, Issue 3. [DOI: 10.1002/14651858.CD004097.pub4] - DOI - PMC - PubMed
Salmeron 1997
    1. Salmeron J, Jenkins DJ, Ascerio A, Stampfer MJ, Rimm EB, et al. Dietary fiber, glycemic load and risk of NIDDM in men. Diabetes Care 1997;20:545‐50. - PubMed
Schulz 1995
    1. Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273:408‐12. - PubMed
Sheard 2004
    1. Sheard NF, Clark NG, Brand‐Miller JC, Franz MJ, Pi‐Sunyer FX, Mayer‐Davis E, Kulkarni K, Geil P. Dietary Carbohydrate (Amount and Type) in the Prevention and Management of Diabetes: A statement by the American Diabetes Association. Diabetes Care 2004;27:2266‐71. - PubMed
Silink 2002
    1. Silink M. Childhood diabetes: a global perspective. Hormone Research 2002;57 Suppl 1:1‐5. - PubMed
Stratton 2000
    1. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. British Medical Journal 2000;321:405‐12. - PMC - PubMed
Tang 2000
    1. Tang JL, Liu JL. Misleading funnel plot for detection of bias in meta‐analysis. Journal of clinical epidemiology 2000;53(5):477‐84. - PubMed
UK PDSG 1995
    1. United Kingdom Prospective Diabetes Study Group. UKPDS 13: relative efficacy of randomly allocated diet, sulphonylurea, insulin or metformin in patients with newly diagnosed non‐insulin dependent diabetes followed for three years. British Medical Journal 1995;310:83‐8. - PMC - PubMed
UKPDS 38 1998
    1. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: (UKPDS 38). BMJ 1998;317:703‐13. - PMC - PubMed
UKPDS33 1998
    1. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood‐glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352:837‐53. - PubMed
Winocour 1988
    1. Winocour P, Bhatnagar D, Kalsi P, Hillier V, Anderson D. Relative clinical usefulness of glycosylated serum albumin and fructosamine during short‐term changes in glycemic control in IDDM. Diabetes Care 1988;12:665‐72. - PubMed

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