Short-term effectiveness of nutrition therapy to treat type 2 diabetes in low-income and middle-income countries: systematic review and meta-analysis of randomised controlled trials

BMJ Open

Mar 2022

DOI: 10.1136/bmjopen-2021-056108

Citations:14

Influential Citations:3

Systematic Reviews / Meta-Analyses

Enhanced Details

Methods

Four randomized controlled trials involving 463 participants from Malaysia, Iran, and South Africa were included. All trials focused on nutrition education and targeting dietary choices rather than direct manipulation of diet or supplements.

Intervention

This review examined the evidence for the effectiveness of nutrition therapy for managing type 2 diabetes mellitus (T2DM) in low- and middle-income countries, focusing specifically on the impact on glycaemic control.

Results

At 3 months, nutrition interventions showed improvement in glycaemic control with HbA1c reduced by 1.11% (95% CI: -1.64 to -0.59) and fasting blood glucose reduced by 23.57 mg/dL (95% CI: -44.3 to -2.84). At 6 months, results were less clear, indicating the need for further research on long-term effects. The overall certainty of evidence was very low due to high risk of bias and poor methodological quality.

Limitations

The review highlighted a lack of sufficient trials with long-term follow-up and noted the very low certainty of the evidence. The majority of studies only assessed short-term outcomes.

Abstract

Objectives This review examined the evidence arising from randomised controlled trials regarding the impact of nutrition therapy on glycaemic control in people living with type 2 diabetes mellitus (T2DM) in low/middle-income countries (LMICs). Design Systematic review and meta-analysis using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Approach. Data sources MEDLINE, EMBASE, Web of Science, OpenGrey and the International Clinical Trials Registry were searched (up to July 3 2020). Eligibility criteria Trials were included if they evaluated nutrition therapy in adults diagnosed with T2DM, were conducted in LMICs, measured glycaemic control and the trial included a 3-month post-intervention assessment. Nutrition therapy was defined according to American Diabetes Association recommendations. Data extraction and synthesis Two independent reviewers screened the database. Study characteristics and outcome data were extracted using a data collection form. Meta-analyses were conducted for glycated haemoglobin (HbA1c) and fasting blood glucose. Trials were assessed for risk of bias (Cochrane Risk-of-Bias, Version 2.0) and overall certainty of evidence (GRADE). Results Four trials met inclusion criteria (total n=463), conducted in Malaysia, Iran and South Africa. All trials focused on nutrition education with no direct prescription or manipulation of diet. Mean differences between intervention and standard care were −0.63% (95% CI −1.47% to 0.21%) for HbA1c and −13.63 mg/dL (95% CI −37.61 to 10.34) for fasting blood glucose in favour of the intervention. Given the small number of eligible trials, moderate to high risk of publication bias and serious concerns regarding consistency and precision of the evidence, certainty of evidence was deemed to be very low. Conclusions There is a lack of well-conducted randomised controlled trials that examine the long-term impact of nutrition therapy in LMICs, preventing firm conclusions to be made on their effectiveness. Further research is essential to discover realistic, evidence-based solutions. PROSPERO registration number CRD42020188435. show less