Efficacy of a meal sequence in patients with type 2 diabetes: a systematic review and meta-analysis

Feb 25, 2022BMJ open diabetes research & care

How the order of eating meals affects people with type 2 diabetes: a review and analysis

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Abstract

In a systematic review of eight trials involving 230 participants, the carbohydrate-later meal pattern (CL) showed no significant impact on hemoglobin A1c (HbA1c) levels.

CL resulted in a mean difference of -0.21% in HbA1c, indicating slight to no change.
Plasma glucose levels increased by an average of 4.94 mg/dL after meals with CL.
Plasma insulin levels decreased by a mean of 3.63 μIU/mL in the intervention group.
Changes in plasma GLP-1 and GIP levels were minimal, with mean differences of +0.43 pmol/L and -2.02 pmol/L, respectively.
All observed outcomes were classified as low-certainty or very low-certainty evidence.
No trials assessed quality of life or documented adverse events related to CL.

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INTRODUCTION: This systematic review investigated the efficacy of a meal sequence, the carbohydrate-later meal pattern (CL), on type 2 diabetes mellitus (T2DM).

RESEARCH DESIGN AND METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov until April 2020 to perform meta-analyses using random-effects models. Primary outcomes were hemoglobin A1c (HbA1c) and quality of life. Secondary outcomes were plasma concentrations of glucose, insulin and incretin 120 min after a meal, and any adverse outcomes. The revised Cochrane risk-of-bias tool and Grading of Recommendations, Assessment, Development, and Evaluation approach were used to assess the quality of individual studies and the body of evidence, respectively. The present study was registered in the UMIN Clinical Trials Registry.

RESULTS: We included 230 participants in eight trials, including both trials that examined long-term changes (more than 2 months and less than 2 years) and short-term changes (in 2-hour postprandial values). CL resulted in a slight to no difference in HbA1c (mean difference (MD), -0.21% in the intervention group; 95% CI -0.44% to+0.03%), plasma glucose (MD,+4.94 mg/dL; 95% CI -8.34 mg/dL to +18.22 mg/dL), plasma insulin (MD, -3.63 μIU/mL; 95% CI -11.88 μIU/mL to +4.61 μIU/mL), plasma GLP-1 (MD, +0.43 pmol/L; 95% CI -0.69 pmol/L to +1.56 pmol/L), and plasma GIP (MD, -2.02 pmol/L; 95% CI -12.34 pmol/L to +8.31 pmol/L). All of these outcomes were of low-certainty evidence or very low-certainty evidence. None of the trials evaluated quality of life or adverse events.

CONCLUSIONS: There was no evidence for the potential efficacy of recommending CL beyond standard dietary advice on T2DM.

TRIAL REGISTRATION NUMBER: UMIN000039979.

Key numbers

-0.21%

HbA1c Change

Mean difference in HbA1c from carbohydrate-later meal patterns.

+4.94 mg/dL

Plasma Glucose Change

Mean difference in plasma glucose 120 min after meals.

230 participants

Participants Included

Total participants from eight trials included in the meta-analysis.

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Efficacy of a meal sequence in patients with type 2 diabetes: a systematic review and meta-analysis

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