Objective To inform the update of the European Association for the Study of Diabetes clinical practice guidelines for nutrition therapy. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Medline, Embase, and the Cochrane Library searched up to 13 May 2021. Eligibility criteria for selecting studies Randomised controlled trials of three or more weeks investigating the effect of diets with low glycaemic index (GI)/glycaemic load (GL) in diabetes. Outcome and measures The primary outcome was glycated haemoglobin (HbA1c). Secondary outcomes included other markers of glycaemic control (fasting glucose, fasting insulin); blood lipids (low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), non-HDL-C, apo B, triglycerides); adiposity (body weight, BMI, waist circumference), blood pressure (systolic blood pressure (SBP) and diastolic blood pressure (DBP)), and inflammation (C reactive protein (CRP)). Data extraction and synthesis Two independent reviewers extracted data and assessed risk of bias. Data were pooled by random effects models. GRADE (grading of recommendations assessment, development, and evaluation) was used to assess the certainty of evidence. Results 29 trial comparisons were identified in 1617 participants with type 1 and 2 diabetes who were predominantly middle aged, overweight, or obese with moderately controlled type 2 diabetes treated by hyperglycaemia drugs or insulin. Low GI/GL dietary patterns reduced HbA1c in comparison with higher GI/GL control diets (mean difference −0.31% (95% confidence interval −0.42 to −0.19%), P<0.001; substantial heterogeneity, I2=75%, P<0.001). Reductions occurred also in fasting glucose, LDL-C, non-HDL-C, apo B, triglycerides, body weight, BMI, and CRP (P<0.05), but not blood insulin, HDL-C, waist circumference, or blood pressure. A positive dose-response gradient was seen for the difference in GL and HbA1c and for absolute dietary GI and SBP (P<0.05). The certainty of evidence was high for the reduction in HbA1c and moderate for most secondary outcomes, with downgrades due mainly to imprecision. Conclusions This synthesis suggests that low GI/GL dietary patterns result in small important improvements in established targets of glycaemic control, blood lipids, adiposity, and inflammation beyond concurrent treatment with hyperglycaemia drugs or insulin, predominantly in adults with moderately controlled type 1 and type 2 diabetes. The available evidence provides a good indication of the likely benefit in this population. Study registration ClinicalTrials.gov [NCT04045938][1]. No additional data are available. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04045938&atom=%2Fbmj%2F374%2Fbmj.n1651.atom

中文翻译：

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低血糖指数或负荷饮食模式对糖尿病患者血糖控制和心脏代谢危险因素的影响：随机对照试验的系统评价和荟萃分析

目的 通报欧洲糖尿病研究协会营养治疗临床实践指南的更新情况。设计随机对照试验的系统评价和荟萃分析。数据来源 Medline、Embase 和 Cochrane 图书馆检索截至 2021 年 5 月 13 日。 选择研究的资格标准 为期三周或以上的随机对照试验，调查低血糖指数 (GI)/血糖负荷 (GL) 饮食对糖尿病的影响。结果和措施 主要结果是糖化血红蛋白 (HbA1c)。次要结局包括血糖控制的其他标志物（空腹血糖、空腹胰岛素）；血脂（低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、非HDL-C、apo B、甘油三酯）；肥胖（体重、BMI、腰围）、血压（收缩压（SBP）和舒张压（DBP））和炎症（C反应蛋白（CRP））。数据提取和合成 两名独立评审员提取数据并评估偏倚风险。通过随机效应模型汇集数据。GRADE（建议评估、制定和评估的分级）用于评估证据的确定性。结果 在 1617 名患有 1 型和 2 型糖尿病的参与者中进行了 29 项试验比较，这些参与者主要是中年、超重或肥胖，患有通过高血糖药物或胰岛素治疗的中等控制的 2 型糖尿病。与高 GI/GL 对照饮食相比，低 GI/GL 饮食模式降低了 HbA1c（平均差 -0.31%（95% 置信区间 -0.42 至 -0.19%），P<0.001；显着异质性，I2=75%，P< 0.001）。空腹血糖、LDL-C、非 HDL-C、apo B、甘油三酯、体重、BMI 和 CRP 也出现降低（P<0.05），但血液胰岛素、HDL-C、腰围或血压没有降低。GL 和 HbA1c 的差异以及绝对膳食 GI 和 SBP 的差异呈正剂量反应梯度（P<0.05）。HbA1c 降低的证据质量较高，大多数次要结局的证据质量中等，降级主要是由于不精确。结论 该综合表明，除了同时使用高血糖药物或胰岛素治疗外，低 GI/GL 饮食模式对血糖控制、血脂、肥胖和炎症等既定目标产生了微小的重要改善，主要是在中等控制的 1 型和 2 型成人中糖尿病。现有证据很好地表明了该人群可能受益。研究注册 ClinicalTrials.gov [NCT04045938][1]。没有其他可用数据。[1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04045938&atom=%2Fbmj%2F374%2Fbmj.n1651.atom