Low carbohydrate diets, glycaemic control, enablers, and barriers in the management of type 1 diabetes: a mixed methods systematic review.

IF 3.4 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Janine Paul, Rati Jani, Sarah Thorning, Mila Obucina, Peter Davoren, Catherine Knight-Agarwal
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引用次数: 0

Abstract

Background: Medical nutrition therapy is fundamental for diabetes management, however there is a lack of evidence supporting an ideal recommended carbohydrate intake for maintaining optimal glycaemia in individuals living with type 1 diabetes (T1D). Adults with T1D are increasingly drawn to very low carbohydrate (≤ 50 g/day or < 10% total energy intake) and low carbohydrate diets (< 130 g/day or < 26% total energy intake) because of the reported positive impact on both physical health and psychological well-being. Current evidence regarding the effectiveness on glycaemia and the lived experience by adults with T1D when using these diets is limited. This mixed methods systematic review was undertaken to examine the effectiveness of very low and low carbohydrate diets on HbA1c and explore the lived experience of adults with T1D who have followed these dietary regimens.

Methods: Seven databases (MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Informit Health Collection, Web of Science, and PsycInfo) were searched from inception to 1 October 2023. Quality assessment of the included studies was undertaken using the JBI's critical appraisal checklists. Separate quantitative and qualitative synthesis was performed, and findings were integrated for the purpose of comparison and complementarity.

Results: Seventeen studies of varying methodologies were included. Findings from quantitative research were inconclusive in determining the effectiveness of very low and low carbohydrate diets on HbA1c levels. Qualitative data synthesis identified four themes [1) Motivation to follow the diet, 2) Health benefits of the diet, 3) Challenges of the diet, and 4) Limited information (participants knowledge, information sources) about the diet] that influenced adherence to very low and low carbohydrate diets. Through the integration of results from selected studies, it was evident that there were conflicting outcomes between quantitative and qualitative studies.

Conclusions: There is little evidence to indicate that very low and low carbohydrate diets improve HbA1c in adults with T1D. However, this goes against the reported lived experiences of participants. This review highlights the insufficiency of robust evidence on this topic. Future research involving larger participant samples over longer durations are needed to provide more definitive evidence in relation to the efficacy of these diets and into the enablers and barriers experienced when using a very low or low carbohydrate diet in order to provide support to adults with T1D. Systematic review registration PROSPERO CRD42023482800.

1 型糖尿病管理中的低碳水化合物饮食、血糖控制、促进因素和障碍:混合方法系统综述。
背景:医学营养治疗是糖尿病管理的基础,但目前缺乏证据支持 1 型糖尿病(T1D)患者维持最佳血糖的理想推荐碳水化合物摄入量。越来越多的成人 1 型糖尿病患者倾向于摄入极低碳水化合物(≤ 50 克/天或以下):检索了从开始到 2023 年 10 月 1 日的七个数据库(MEDLINE、Embase、CINAHL、Cochrane CENTRAL、Informit Health Collection、Web of Science 和 PsycInfo)。对纳入研究的质量评估采用了 JBI 的批判性评估核对表。分别进行了定量和定性综合,并对研究结果进行了整合,以便进行比较和互补:结果:共纳入了 17 项方法各异的研究。定量研究结果无法确定极低碳水化合物和低碳水化合物饮食对 HbA1c 水平的有效性。定性数据综合确定了影响坚持极低碳水化合物和低碳水化合物饮食的四个主题[1) 坚持饮食的动机;2) 饮食对健康的益处;3) 饮食面临的挑战;4) 有关饮食的有限信息(参与者的知识、信息来源)]。通过整合所选研究的结果,可以明显看出定量研究和定性研究的结果存在冲突:结论:几乎没有证据表明极低碳水化合物和低碳水化合物饮食能改善 T1D 成人患者的 HbA1c。结论:几乎没有证据表明极低碳水化合物和低碳水化合物饮食可改善 T1D 成人患者的 HbA1c,但这与参与者报告的生活经验相悖。本综述强调了有关该主题的有力证据不足。未来的研究需要涉及更多的参与者样本和更长的持续时间,以提供与这些饮食疗效相关的更明确的证据,并研究使用极低或低碳水化合物饮食为 T1D 成人患者提供支持时遇到的促进因素和障碍。系统综述注册号为 PROSPERO CRD42023482800。
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来源期刊
Diabetology & Metabolic Syndrome
Diabetology & Metabolic Syndrome ENDOCRINOLOGY & METABOLISM-
CiteScore
6.20
自引率
0.00%
发文量
170
审稿时长
7.5 months
期刊介绍: Diabetology & Metabolic Syndrome publishes articles on all aspects of the pathophysiology of diabetes and metabolic syndrome. By publishing original material exploring any area of laboratory, animal or clinical research into diabetes and metabolic syndrome, the journal offers a high-visibility forum for new insights and discussions into the issues of importance to the relevant community.
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