Transtheoretical Model-based Dietary and Exercise Interventions for Glycemic Control in Type 2 Diabetes: Systematic Review and Meta-analysis.

Effects of soluble fiber supplementation on glycemic control in adults with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials

PurposeFindings from randomized controlled trials (RCTs) evaluating the effect of pulse intake on glycemic control are inconsistent and conclusive evidence is lacking. The aim of this study was to systematically review the impact of pulse consumption on post-prandial and long-term glycemic control in adults with and without type 2 diabetes (T2D).MethodsDatabases were searched for RCTs, reporting outcomes of post-prandial and long-term interventions with different pulse types on parameters of glycemic control in normoglycemic and T2D adults. Effect size (ES) was calculated using random effect model and meta-regression was conducted to assess the impact of various moderator variables such as pulse type, form, dose, and study duration on ES.ResultsFrom 3334 RCTs identified, 65 studies were eligible for inclusion involving 2102 individuals. In acute RCTs, pulse intake significantly reduced peak post-prandial glucose concentration in participants with T2D (ES – 2.90; 95%CI – 4.60, – 1.21; p ≤ 0.001; I2 = 93%) and without T2D (ES – 1.38; 95%CI – 1.78, – 0.99; p ≤ 0.001; I2 = 86%). Incorporating pulse consumption into long-term eating patterns significantly attenuated fasting glucose in normoglycemic adults (ES – 0.06; 95%CI – 0.12, 0.00; p ≤ 0.05; I2 = 30%). Whereas, in T2D participants, pulse intake significantly lowered fasting glucose (ES – 0.54; 95%CI – 0.83, – 0.24; p ≤ 0.001; I2 = 78%), glycated hemoglobin A1c (HbA1c) (ES – 0.17; 95%CI – 0.33, 0.00; p ≤ 0.05; I2 = 78) and homeostatic model assessment of insulin resistance (HOMA-IR) (ES – 0.47; 95%CI – 1.25, – 0.31; p ≤ 0.05; I2 = 79%).ConclusionPulse consumption significantly reduced acute post-prandial glucose concentration > 1 mmol/L in normoglycemic adults and > 2.5 mmol/L in those with T2D, and improved a range of long-term glycemic control parameters in adults with and without T2D.PROSPERO registry number(CRD42019162322).

Background/Objective: The rising prevalence of Type 2 Diabetes Mellitus (T2DM), coupled with sedentary behavior and an increase in obesity rates in South Asian countries, calls for effective management strategies. We aimed to assess the efficacy of lifestyle interventions on glycemic control among adults with T2DM in South Asian countries. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted to assess the effectiveness of lifestyle interventions on glycemic control in adults diagnosed with T2DM in South Asia. We conducted a comprehensive search in CINAHL, Embase, PubMed, Cochrane Library, Web of Science (WoS), and Scopus to identify related studies published from 2000 to 13 June 2024. We assessed the risk of bias using the ROB 2.0 tool and calculated the pooled mean differences in HbA1c and FBG levels under a random-effects model. We conducted subgroup and leave-one-out sensitivity analyses to assess and explore sources of heterogeneity. PROSPERO Registration: CRD42024552286. Results: We included 16 RCTs with a total of 1499 participants. Lifestyle interventions reduced HbA1c levels by 0.86% (95% CI: −1.30 to −0.42, p < 0.01) and FBG levels by 22.49 mg/dL (95% CI: −32.88 to −12.10, p < 0.01). We observed substantial heterogeneity (I2 = 98% for HbA1c and I2 = 87% for FBG). Subgroup analyses indicated larger HbA1c reductions in long-term (−1.44%) than short-term trials (−0.62%), and greater FBG decreases in long-term (−23.7 mg/dL) versus short-term studies (−22.5 mg/dL). Physical activity interventions had the largest improvements (HbA1c −0.99%; FBG −26.1 mg/dL), followed by dietary (HbA1c −0.59%; FBG −15.8 mg/dL) and combined programs (HbA1c −0.55%). Participants aged >50 years achieved greater glycemic improvements (HbA1c −0.92%; FBG −24.0 mg/dL) compared to younger adults (HbA1c −0.60%; FBG −21.3 mg/dL). Despite high heterogeneity, sensitivity analyses confirmed the robustness of the overall findings. Conclusions: Lifestyle modifications yielded a clinically significant reduction in HbA1c and FBG in adults with T2DM in South Asia. Although heterogeneity of the included studies was substantial, the direction of the effects was uniformly consistent across subgroups. To further validate these findings and assess their long-term effects, large-scale and standardized RCTs conducted for longer durations are necessary.

Lactic acid bacteria (LAB) fermented foods are reported to have potential in managing glycemic control. This systematic review aimed to evaluate the effectiveness of LAB-fermented foods on improving glycemic control in adults with prediabetics or type 2 diabetes mellitus (T2DM). Randomized controlled trials (RCTs) on LAB fermentation-related foods were searched on PubMed, Cochrane, Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science. Sixteen RCTs were included, and the results concluded LAB-fermented food had significant effects in HbA1c (Z = 6.24, MD = −0.05, CI: −0.07 to −0.04, p ≤ 0.00001), fasting plasma glucose (Z = 2.50, MD = −0.16, CI: −0.29 to −0.04, p = 0.01) and fasting serum insulin (Z = 2.51, MD = −0.20, CI: −0.35 to −0.04, p = 0.01). There were significant effects on lipid profile, inflammatory markers, and body mass index in secondary analyses. Subgroup analysis suggests LAB-fermented consumption with a longer duration, younger age group and adults with T2DM, had a larger effect size. Clinicians could offer LAB-fermented food as dietary recommendations for prediabetic and diabetic adults. Larger trials are warranted to verify LAB-fermented food benefits on glycemic control. Systematic Review Registration: PROSPERO Registration No. CRD42022295220

Adolescents and young adults with type 1 diabetes exhibit the worst glycemic control among individuals with type 1 diabetes across the lifespan. Although continuous glucose monitoring (CGM) has been shown to improve glycemic control in adults, its benefit in adolescents and young adults has not been demonstrated. To determine the effect of CGM on glycemic control in adolescents and young adults with type 1 diabetes. Randomized clinical trial conducted between January 2018 and May 2019 at 14 endocrinology practices in the US including 153 individuals aged 14 to 24 years with type 1 diabetes and screening hemoglobin A1c (HbA1c) of 7.5% to 10.9%. Participants were randomized 1:1 to undergo CGM (CGM group; n = 74) or usual care using a blood glucose meter for glucose monitoring (blood glucose monitoring [BGM] group; n = 79). The primary outcome was change in HbA1c from baseline to 26 weeks. There were 20 secondary outcomes, including additional HbA1c outcomes, CGM glucose metrics, and patient-reported outcomes with adjustment for multiple comparisons to control for the false discovery rate. Among the 153 participants (mean [SD] age, 17 [3] years; 76 [50%] were female; mean [SD] diabetes duration, 9 [5] years), 142 (93%) completed the study. In the CGM group, 68% of participants used CGM at least 5 days per week in month 6. Mean HbA1c was 8.9% at baseline and 8.5% at 26 weeks in the CGM group and 8.9% at both baseline and 26 weeks in the BGM group (adjusted between-group difference, -0.37% [95% CI, -0.66% to -0.08%]; P = .01). Of 20 prespecified secondary outcomes, there were statistically significant differences in 3 of 7 binary HbA1c outcomes, 8 of 9 CGM metrics, and 1 of 4 patient-reported outcomes. The most commonly reported adverse events in the CGM and BGM groups were severe hypoglycemia (3 participants with an event in the CGM group and 2 in the BGM group), hyperglycemia/ketosis (1 participant with an event in CGM group and 4 in the BGM group), and diabetic ketoacidosis (3 participants with an event in the CGM group and 1 in the BGM group). Among adolescents and young adults with type 1 diabetes, continuous glucose monitoring compared with standard blood glucose monitoring resulted in a small but statistically significant improvement in glycemic control over 26 weeks. Further research is needed to understand the clinical importance of the findings. ClinicalTrials.gov Identifier: NCT03263494.

Objectives: Diabetes Mellitus (DM) is a global and progressive chronic medical condition with increasing prevalence and associated costs throughout the world. Psychological problems are common in people with DM and when they co-occur are associated with negative patient and societal outcomes. Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) were to be effective in treating a variety of psychological problems in various health conditions. Thus, using MBSR and MBCT in DM patients may help alleviate psychological problems of anxiety and depression and improve glycaemic control as a result. In this systematic review, we investigated the effectiveness of MBSR and MBCT in improving glycaemic control, anxiety and depression in adults with DM. Interventions: Randomised-Controlled Trials (RCTs) and Pilot Studies (RCPS) evaluated the effectiveness of MBSR or MBCT. Electronic searches were carried out of the following databases CINAHL, CENTRAL, EMBASE, MEDLINE, PsycINFO, PubMed, and ongoing clinical trials websites. Main outcomes: This research examined the effectiveness of MBSR and MBCT on depression, anxiety and glycaemic control in adults with T1DM or T2DM. Results: Research evidence has shown that patients with mental illnesses such as schizophrenia and anxiety disorders have a higher risk of developing DM than the general population. Explicitly, evidence indicates that the prevalence of psychological problems is much higher than in the general population and globally, with a two-fold increase in the prevalence of depression and anxiety in DM patients. 3 RCTs and 1 RCPS found a total of 365 participants. Narrative and data synthesis indicated significant reduction in levels of anxiety and depression at short-term and long-term time points. However, no significant effect on glycaemic control was established. MBSR and MBCT are feasible and efficacious methods for depression and anxiety treatment in adults with T1DM or T2DM.

Background/objectivesIn people with type 2 diabetes mellitus (T2DM), low carbohydrate diets (LCD), defined as 10–<26% total energy intake from carbohydrate, have indicated improved glycaemic control and clinical outcomes. Web-based interventions can help overcome significant challenges of accessibility and availability of dietary education and support for T2DM. No previous study had evaluated a web-based LCD intervention using a randomised controlled trial (RCT) design. The objective of this study was to assess whether a web-based LCD programme provided in conjunction with standard care improves glycaemic control in adults with T2DM.Subjects/methodsA 16-week parallel RCT was conducted remotely during Covid-19 among the general community, recruiting adults with T2DM not on insulin aged 40–89 years. Participants were randomly assigned (1:1) to standard care plus the web-based T2Diet healthy LCD education programme (intervention) or standard care only (control). The primary outcome was haemoglobin A1c (HbA1c). Secondary outcomes were weight, body mass index (BMI), anti-glycaemic medication, dietary intake, and self-efficacy. Blinded data analysis was conducted by intention-to-treat.ResultsNinety-eight participants were enrolled, assigning 49 to each group, with 87 participants (n = 40 intervention; n = 47 control) included in outcome analysis. At 16 weeks, there was a statistically significant between-group difference favouring the intervention group, with reductions in HbA1c –0.65% (95% CI: –0.99 to –0.30; p < 0.0001), weight –3.26 kg (p < 0.0001), BMI –1.11 kg/m2 (p < 0.0001), and anti-glycaemic medication requirements –0.40 (p < 0.0001), with large effect sizes Cohen’s d > 0.8.ConclusionThis study demonstrated that as an adjunct to standard care, the web-based T2Diet programme significantly improved glycaemic control and clinical outcomes in adults with T2DM. In addition, the results highlight the potential to improve access and availability for people with T2DM to achieve glycaemic control and improved health through web-based dietary education and support.

BackgroundGlobally, the prevalence of type 1 diabetes mellitus (T1DM) is rising. In 2020, a total of 124,652 Australians had T1DM. Maintaining optimal glycemic control (hemoglobin A1c ≤7.0%, ≤53 mmol/mol) on a standard carbohydrate diet can be a challenge for people living with T1DM. The Diabetes Complications and Control Trial established that macrovascular and microvascular complications could be reduced by improving glycemic control. Recent studies have found that a very low or low carbohydrate diet can improve glycemic control. However, the overall evidence relating to an association between a very low or low carbohydrate diet and glycemic control in people living with T1DM is both limited and mixed. In addition, research has suggested that a reduced quality of life due to anxiety and depression adversely influences glycemic control. Despite a potential link between a very low or low carbohydrate diet and optimal glycemic control, to our knowledge, no research has examined an association between a low carbohydrate diet, quality of life, and glycemic control, making this study unique in its approach.ObjectiveThe study aims to develop a validated diabetes-specific quality of life questionnaire for use in Australian adults with T1DM and to determine if an association exists between a low carbohydrate diet, quality of life, and glycemic control in Australian adults living with T1DM.MethodsThis cross-sectional study will be conducted in a tertiary hospital outpatient setting and will consist of 3 phases: phase 1, online Australian diabetes-specific quality of life questionnaire development and piloting (25-30 adults with T1DM); phase 2, questionnaire validation (364 adults with T1DM); and phase 3, a 12-week dietary intervention to determine if an association exists between a low carbohydrate diet, quality of life, and glycemic control in adults with T1DM (16-23 adults with T1DM). The validation of the study-developed Australian diabetes-specific quality of life questionnaire, and changes in hemoglobin A1c and quality of life in adults with T1DM while undertaking a low carbohydrate diet over 12 weeks will be the primary outcomes of this study.ResultsPhase 1 of the study is currently open for recruitment and has recruited 12 participants to date. It is anticipated that the first results will be submitted for publication in November 2021. Presently, no results are available.ConclusionsThis study is the first of its kind in that it will be the first to generate a new validated instrument, which could be used in evidence-based practice and research to understand the quality of life of Australian adults with T1DM. Second, the low carbohydrate dietary intervention outcomes could be used to inform clinicians about an alternative approach to assist T1DM adults in improving their quality of life and glycemic control. Finally, this study could warrant the development of an evidence-based low carbohydrate dietary guideline for adults living with T1DM with the potential to have a profound impact on this population.Trial RegistrationClinicalTrials.gov NCT04213300; https://clinicaltrials.gov/ct2/show/NCT04213300International Registered Report Identifier (IRRID)PRR1-10.2196/25085

Exploring the effect of adhering to a healthy lifestyle pattern on glycemic control in adults with type 1 diabetes mellitus.

Background/Objectives: Diabetes mellitus (DM) is a major global health concern, yet limited research has examined how sociodemographic factors and physical activity (PA) influence glycaemic control within specific national contexts. This pilot study explored associations between sociodemographic and behavioral factors and glycaemic regulation among adults with DM in Croatia. Methods: A cross-sectional study was conducted at a national reference center, including 95 adults with type 1 or type 2 diabetes. Data on demographics, clinical characteristics, and PA were obtained through questionnaires and medical records. Descriptive statistics, Welch’s t-tests, χ2 tests, correlations, and regression analyses were applied to identify predictors of HbA1c and diabetes-related complications. Glycaemic control was categorized as optimal (HbA1c ≤ 7.5%) or suboptimal (>7.5%) according to the pragmatic clinical threshold commonly used in DM management. Results: Mean HbA1c was 6.9% (SD = 1.3), with 33.7% of participants above 7.5%. Higher education (β = −0.48, p = 0.013) and participation in strength or balance exercises (β = −0.32, p = 0.041) were associated with lower HbA1c, whereas longer disease duration (β = 0.03, p = 0.004) and type 2 diabetes (β = 0.38, p = 0.030) predicted higher HbA1c. In logistic regression, age predicted cardiovascular comorbidities (OR = 1.12, 95% CI 1.02–1.23, p = 0.019). The interaction between PA and place of residence (urban vs. rural) showed a non-significant trend (p = 0.061). Conclusions: Glycaemic control in Croatian adults with diabetes was associated with educational level and engagement in strength and balance exercises, while longer disease duration, older age, and type 2 diabetes were linked to poorer regulation and more complications. These findings underscore the importance of structured exercise and patient education in diabetes management, although larger, prospective studies with standardized PA-intensity measures are required to confirm and extend these results.

The ingestion of Lactiplantibacillus plantarum OLL2712 (OLL2712) cells has been shown to improve glucose metabolism by suppressing chronic inflammation in murine models and clinical studies. This study aimed to clarify the effect of OLL2712 on glycaemic control in healthy adults with prediabetes. The study was a randomized, double-blind, placebo-controlled, parallel-group design. Adult participants with prediabetes [n = 148, glycated haemoglobin (HbA1c) range: 5.6%-6.4%, age range: 20-64 years] were assigned randomly to placebo or OLL2712 groups (n = 74/group) and administered daily for 12 weeks either conventional yogurt or yogurt containing >5 × 109 heat-treated OLL2712 cells, respectively. In addition, the participants were followed for 8 weeks after the discontinuation of either yogurt. The primary outcome was the changes in HbA1c levels at weeks 12 and 16 by analysis of covariance. The levels of HbA1c and glycoalbumin decreased significantly in both groups at week 12 in comparison with those at week 0, but only in the OLL2712 group at week 16. HbA1c levels decreased significantly at weeks 12 and 16 in the OLL2712 group in comparison with the placebo group (p = .014 and p = .006, respectively). No significant inter- and intragroup differences in HbA1c levels were observed at week 20. The ingestion of OLL2712 prevents the deterioration of glycaemic control and maintains the HbA1c levels within the normal range in adults with prediabetes; yogurt probably exhibits similar effects, which may contribute to reducing the risk of developing type 2 diabetes.

Evidence from observational, animal and human studies supports a role for soya protein and its isoflavones in the improvement of glycaemic control in type 2 diabetes. The objective of the present study was to determine the effect of isoflavone-rich soya protein on markers of glycaemic control in adults with type 2 diabetes. Using a randomised, crossover, double-blind, placebo-controlled design, adults with diet-controlled type 2 diabetes (n 29) consumed soya protein isolate (SPI) and milk protein isolate (MPI) for 57 d each separated by a 4-week washout. Blood was collected on days 1 and 57 of each treatment period for analysis of fasting HbA1C, and fasting and postprandial glucose, insulin and calculated indices of insulin sensitivity and resistance. Urine samples of 24 h were collected at the end of each treatment period for analysis of isoflavones. Urinary isoflavone excretion was significantly greater following consumption of SPI compared with MPI, and 20.7 % of the subjects (n 6) were classified as equol excretors. SPI consumption did not significantly affect fasting or postprandial glucose or insulin, fasting HbA1C, or indices of insulin sensitivity and resistance. These data do not support a role for soya protein in the improvement of glycaemic control in adults with diet-controlled type 2 diabetes and contribute to a limited literature of human studies on the effects of soya protein on the management of type 2 diabetes.

Type 2 diabetes mellitus (T2DM) is a global health issue, affecting over 537 million adults in 2021, with projections reaching 783 million by 2045. The rising prevalence, driven by urbanization, aging populations, and sedentary lifestyles, underscores the need for effective and sustainable management strategies. Plant-based diets have emerged as a promising intervention for improving glycemic control and metabolic health. This systematic review assessed whether adherence to plant-based diets, compared to standard diabetic diets, improves glycemic control and reduces HbA1c levels in adults with T2DM. A comprehensive search was conducted in PubMed, Agricola, and related databases, following PRISMA guidelines. Eligible studies published between 2014 and 2024, included randomized controlled trials and cohort studies assessing plant-based diets in adults with T2DM. Key outcomes included changes in HbA1c and fasting glucose. Data extraction and quality assessments followed standardized methodologies. Sixteen studies met the inclusion criteria. Findings demonstrated consistent HbA1c reductions (0.6%–0.9%) and fasting glucose improvements (12–18 mg/dL) in plant-based diet groups compared to controls. Additional benefits included weight loss, reduced medication reliance, and improved cardiovascular markers. These effects were evident across diverse populations and dietary patterns. Plant-based diets offer a compelling approach to glycemic control and metabolic health in adults with T2DM. These findings align with global dietary guidelines and underscore the importance of long-term research to evaluate sustainability and broader applicability.

The aim was to evaluate the effectiveness of sensor-augmented pump therapy with predictive low-glucose suspend function (SAP-PLGS) in real-world use in children and adults with type 1 diabetes (T1D). Patients with T1D treated with the MiniMed 640G® pump with PLGS function at three referral hospitals were retrospectively evaluated. HbA1c at baseline and at 6, 12, 18, and 24 months was analyzed. Two weeks of data from pumps, sensors, and/or glucose meters were downloaded. Patients completed satisfaction questionnaires at the last follow-up visit. A total of 162 patients were included. Mean age was 32 ± 17 years, 28% were (n = 46) children, and 29% (n = 47) were with a history of severe hypoglycemia. Median follow-up was 12 months (6-18). HbA1c was reduced from 55 ± 9 to 54 ± 8 mmol/mol (7.2% ± 0.8% to 7.1% ± 0.7%) at 12 months (P < 0.03, n = 100). In patients with suboptimal control, there was a reduction in HbA1c from 66% ± 7% to 61 ± 10 mmol/mol (8.2% ± 0.6% to 7.7% ± 0.9%) at the end of follow-up (n = 26, P < 0.01). Three percent (n = 5) of the patients experienced severe hypoglycemia during follow-up. A reduction in the percentage of self-monitoring of blood glucose values <70 mg/dL was achieved (10% ± 7% to 6% ± 5%, P = 0.001, n = 144). Time in range 70-180 mg/dL was 67% ± 13% at the end of follow-up and predictors of a higher time in range were identified. The use of sensors was high (86%) and 73% of the patients showed high satisfaction. In patients using sensors at baseline (n = 54), the time spent at <54 and <70 mg/dL was reduced. SAP-PLGS reduces hypoglycemia frequency while maintaining glycemic control in adults and children under real-life conditions.

Tirzepatide (Mounjaro®), a first-in-class dual incretin agonist of the glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors, is approved for use as an adjunct to diet and exercise to improve glycaemic control in adults with type 2 diabetes mellitus (T2DM) in the USA, EU, Japan and other countries. It comes as single-dose prefilled pens and single-dose vials. In phase III SURPASS trials, once-weekly subcutaneous tirzepatide, as monotherapy or add-on-therapy to oral glucose-lowering medications and insulin, was superior to the GLP-1 receptor agonists (RAs) dulaglutide 0.75mg and semaglutide 1mg as well as basal and prandial insulin for glycaemic control and weight loss in adults with inadequately controlled T2DM. Tirzepatide was generally well tolerated, with a safety profile consistent with that of GLP-1 RAs. Tirzepatide was associated with a low risk of clinically significant or severe hypoglycaemia and no increased risk of major adverse cardiovascular events. Adverse events were mostly mild to moderate in severity, with the most common being gastrointestinal events including nausea, diarrhoea, decreased appetite and vomiting. In conclusion, tirzepatide is a valuable addition to the treatment options for T2DM.