Carbohydrate quantity in the dietary management of type 2 diabetes: A systematic review and meta‐analysis

Korsmo‐Haugen, Henny‐Kristine; Brurberg, Kjetil G.; Mann, Jim; Aas, Anne‐Marie

doi:10.1111/dom.13499

Cited by 115Diet and metabolism studiesDietary Effects on HealthDiabetes Management and Research

Carbohydrate quantity in the dietary management of type 2 diabetes: A systematic review and meta‐analysis

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Korsmo‐Haugen, Henny‐Kristine, Brurberg, Kjetil G., Mann, Jim, Aas, Anne‐Marie·2019·Diabetes, Obesity and Metabolism

DOI 10.1111/dom.13499

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Abstract

Aims: This systematic review and meta‐analysis (registration number: CRD42013005825) compares the effects of low carbohydrate diets (LCDs) on body weight, glycaemic control, lipid profile and blood pressure with the effects of higher carbohydrate diets (HCDs) in adults with type 2 diabetes. Methods: MEDLINE, EMBASE, CENTRAL, CINAHL, Food Science Source and SweMed+ databases were systematically searched to identify randomized controlled trials (duration ≥3 months) investigating the effects of an LCD compared to an HCD in the management of type 2 diabetes. Data were extracted and pooled using a random effects model and were expressed as mean differences and risk ratio. Subgroup analyses were undertaken to examine the effects of duration of intervention, extent of carbohydrate restriction and risk of bias. The certainty of evidence was assessed using GRADE. Results: Of the 1589 studies identified, 23, including 2178 participants, met inclusion criteria. Reductions were slightly greater with LCDs than with HCDs for HbA1c (−1.0 mmol/mol; CI, −1.9, −0.1 [−0.09%; CI, −0.17, −0.01]) and for triglycerides (−0.13 mmol/L; CI, −0.24, −0.02). Changes in weight, HDL‐ and LDL‐cholesterol, total cholesterol and blood pressure did not differ significantly between groups. Subgroup analyses suggested that the difference in HbA1c was evident only in studies with a duration of ≤6 months and with a high risk of bias. Conclusions: The proportion of daily energy provided by carbohydrate intake is not an important determinant of response to dietary management, especially when considering longer term trials. A range of dietary patterns, including those traditional in Mediterranean countries, seems suitable for translating nutritional recommendations for individuals with diabetes into practical advice.

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In the protocol driven approach, the review explored seven actively debated potential effect modifiers using published, explicit subgroup credibility criteria.
“Whereas previous reviews have focused on one or two potential modifiers—for example, Korsmo et al, who explored subgroups on length of follow-up and carbohydrate intake,57 and Naude et al, who explored calorically matched controls14—in our protocol driven approach, we explored seven actively debated potential effect modifiers by using published, explicit subgroup credibility criteria.”
From Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data (2021) · cites this paper as [57]
Only seven meta-analyses were assessed as high quality.
“Only seven meta-analyses (LCDs, n = 5 [37–40, 41]; liquid meal replacement, n = 1 [42]; very low energy diet (VLED), n = 1 [43]) were assessed as high quality.”
From Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission (2022) · cites this paper as [37]
Four high-quality meta-analyses reported that LCDs and higher-carbohydrate diets were equally effective for weight loss, with mean difference ranging between <1 and <2.5 kg, at all durations.
“Four high-quality meta-analyses [37–40] reported that LCDs and higher-carbohydrate diets were equally effective for weight loss, with mean difference ranging between <1 and <2.5 kg, at all durations.”
From Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission (2022) · cites this paper as [37]
RCTs with high risk of bias showed greater weight loss for LCDs than higher-carbohydrate diets (WMD −1.8 kg; 95% CI −2.8, −0.7).
“A subgroup analysis of RCTs with low risk of bias reported no difference (WMD 0.9 kg; 95% CI -1.9, 3.6), while RCTs with high risk of bias showed greater weight loss for LCDs than higher-carbohydrate diets (WMD −1.8 kg; 95% CI −2.8, −0.7) [37].”
From Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission (2022) · cites this paper as [37]
Adherence assessed up to 1 year was poorer with very low-carbohydrate diets (<50 g of carbohydrate) than with LCDs (<130 g of carbohydrate).
“Adherence assessed up to 1 year was poorer with very low-carbohydrate diets (<50 g of carbohydrate) than with LCDs (<130 g of carbohydrate) [34, 37, 40]”
From Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission (2022) · cites this paper as [37]

Very low-carbohydrate diets (21-70 g of carbohydrate daily) showed no greater weight loss than higher-carbohydrate diets over durations of 3-36 months (WMD −0.7 kg; 95% CI −2.0, 0.7; I2 = 46%, p = 0.10).
“Very low-carbohydrate diets (21–70 g of carbohydrate daily) showed no greater weight loss than higher-carbohydrate diets over durations of 3–36 months (weight mean difference [WMD] −0.7 kg; 95% CI −2.0, 0.7; I2 = 46%, p = 0.10) in a subgroup analysis [37].”
From Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission (2022) · cites this paper as [37]
A subgroup analysis of RCTs with low risk of bias reported no difference in weight loss between LCDs and higher-carbohydrate diets (WMD 0.9 kg; 95% CI -1.9, 3.6).
“A subgroup analysis of RCTs with low risk of bias reported no difference (WMD 0.9 kg; 95% CI -1.9, 3.6), while RCTs with high risk of bias showed greater weight loss for LCDs than higher-carbohydrate diets (WMD −1.8 kg; 95% CI −2.8, −0.7) [37].”
From Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission (2022) · cites this paper as [37]
No single eating plan approach has been proven to be consistently superior for weight loss in people with diabetes.
“However, no single approach has been proven to be consistently superior (70,(123)(124)(125), and more data are needed to identify and validate those meal plans that are optimal with respect to long-term outcomes and acceptability.”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023 (2023) · cites this paper as [125]
Weight reduction was also a goal in many low-carbohydrate studies, which complicates evaluating the distinct contribution of the eating pattern.
“Weight reduction was also a goal in many low-carbohydrate studies, which further complicates evaluating the distinct contribution of the eating pattern (47,121,125,167).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023 (2023) · cites this paper as [125]
Systematic reviews and meta-analyses of RCTs found carbohydrate-restricted eating patterns, particularly low carbohydrate (<26% total energy), were effective in reducing A1C in the short term (<6 months), with less difference in eating patterns beyond 1 year.
“Systematic reviews and meta-analyses of RCTs found carbohydrate-restricted eating patterns, particularly those considered low carbohydrate (<26% total energy), were effective in reducing A1C in the short term (<6 months), with less difference in eating patterns beyond 1 year (125,126,137,138,164).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023 (2023) · cites this paper as [125]

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Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial
Lean, M. E. J., Leslie, W. S., Barnes, A. C., Brosnahan, N., Thom, G., McCombie, L., Peters, C., Zhyzhneuskaya, S., Al-Mrabeh, A., Hollingsworth, K. G., et al. (2019) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(19)30068-3 · Cited by 981 · see citing works
“However, meta-analyses of the controlled trial evidence show no important differences between high and low carbohydrate diets for weight control or HbA1c.(31) Low intensity support and follow-up to establish longer term outcomes in DiRECT are currently funded to continue for all participants to a total of 3 years from…”
Background
Comprehensive management of cardiovascular risk factors for adults with type 2 diabetes: a scientific statement from the American Heart Association
Joseph, J. J., Deedwania, P., Acharya, T., Aguilar, D., Bhatt, D. L., Chyun, D. A., Di Palo, K. E., Golden, S. H., Sperling, L. S., & on behalf of the American Heart Association Diabetes Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, T. A. V. B. C. O. C. C. A. C. O. H. (2022) · Circulation · doi:10.1161/cir.0000000000001040 · Cited by 660 · see citing works
Dietary fibre and whole grains in diabetes management: Systematic review and meta-analyses
Reynolds, A. N., Akerman, A. P., & Mann, J. (2020) · PLOS Medicine · doi:10.1371/journal.pmed.1003053 · Cited by 567 · see citing works
Self-citation
An Update on the Epidemiology of Type 2 Diabetes
Tinajero, M., & Malik, V. (2021) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2021.05.013 · Cited by 505 · see citing works
Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data
Goldenberg, J. Z., Day, A., Brinkworth, G. D., Sato, J., Yamada, S., Jönsson, T., Beardsley, J., Johnson, J. A., Thabane, L., & Johnston, B. C. (2021) · BMJ · doi:10.1136/bmj.m4743 · Cited by 428 · see citing works
Review of current evidence and clinical recommendations on the effects of low-carbohydrate and very-low-carbohydrate (including ketogenic) diets for the management of body weight and other cardiometabolic risk factors: A scientific statement from the National Lipid Association Nutrition and Lifestyle Task Force
Kirkpatrick, C. F., Bolick, J. P., Kris-Etherton, P. M., Sikand, G., Aspry, K. E., Soffer, D. E., Willard, K.-E., & Maki, K. C. (2019) · Journal of Clinical Lipidology · doi:10.1016/j.jacl.2019.08.003 · Cited by 390 · see citing works
“Two other metaanalyses did not find a significant difference between diet groups for either SBP or DBP.(57,67) A critical review(80) of 12 RCTs reported no difference between low-CHO and HCLF diets, except in two studies: one showed a greater reduction in SBP (23.”
BackgroundMethodInfluential
5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023
ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D., Johnson, E. L., et al. (2023) · Diabetes Care · doi:10.2337/dc23-s005 · Cited by 362 · see citing works
5. Facilitating Behavior Change and Well-being to Improve Health Outcomes:Standards of Medical Care in Diabetes—2022
American Diabetes Association Professional Practice Committee (2022) · Diabetes Care · doi:10.2337/dc22-s005 · Cited by 445 · see citing works
5. Facilitating Behavior Change and Well-being to Improve Health Outcomes:Standards of Medical Care in Diabetes—2021
American Diabetes Association (2021) · Diabetes Care · doi:10.2337/dc21-s005 · Cited by 299 · see citing works
“Systematic reviews and meta-analyses of randomized controlled trials found carbohydrate-restricted eating patterns, particularly those considered very low carbohydrate (,26% total energy), were effective in reducing A1C in the short term (,6 months), with less difference in eating patterns beyond 1 year (73,74,103,115…”
Background
5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J. B., Eichorst, B., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s005 · Cited by 305 · see citing works
5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2024
ElSayed, N. A., Aleppo, G., Bannuru, R. R., Beverly, E. A., Bruemmer, D., Collins, B. S., Darville, A. K., Ekhlaspour, L., Hassanein, M. M., Hilliard, M. E., et al. (2023) · Diabetes Care · doi:10.2337/dc24-s005 · Cited by 325 · see citing works
Evidence-based European recommendations for the dietary management of diabetes
The Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD), Aas, A.-M., Axelsen, M., Churuangsuk, C., Hermansen, K., Kendall, C. W. C., Kahleova, H., Khan, T., Lean, M. E. J., Mann, J. I., et al. (2023) · Diabetologia · doi:10.1007/s00125-023-05894-8 · Cited by 262 · see citing works
“…have shown that when nutrient-com-plete low-carbohydrate diets are compared head-to-head, they are equally effective as higher carbohydrate (low-fat) diets, without any clinically significant long-term differences in glycaemic levels, lipids, blood pressure or weight management [69, 93–95].”
InfluentialSelf-citation
Effect of low glycaemic index or load dietary patterns on glycaemic control and cardiometabolic risk factors in diabetes: systematic review and meta-analysis of randomised controlled trials
Chiavaroli, L., Lee, D., Ahmed, A., Cheung, A., Khan, T. A., Blanco, S., Mejia, Mirrahimi, A., Jenkins, D. J. A., Livesey, G., et al. (2021) · BMJ · doi:10.1136/bmj.n1651 · Cited by 215 · see citing works
Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission
Churuangsuk, C., Hall, J., Reynolds, A., Griffin, S. J., Combet, E., & Lean, M. E. J. (2022) · Diabetologia · doi:10.1007/s00125-021-05577-2 · Cited by 204 · see citing works
“carbohydrate diets (<50 g of carbohydrate) than with LCDs (<130 g of carbohydrate) [34, 37, 40], possibly because most of the trials allowed increased carbohydrate intake for later weight loss maintenance.”
Background
The Burden of Carbohydrates in Health and Disease
Clemente‐Suárez, V. J., Mielgo‐Ayuso, J., Martín-Rodríguez, A., Ramos‐Campo, D. J., Redondo-Flórez, L., & Tornero-Aguilera, J. F. (2022) · Nutrients · doi:10.3390/nu14183809 · Cited by 223 · see citing works
Effects of Popular Diets on Anthropometric and Cardiometabolic Parameters: An Umbrella Review of Meta-Analyses of Randomized Controlled Trials
Dinu, M., Pagliai, G., Angelino, D., Rosi, A., Dall'Asta, M., Bresciani, L., Ferraris, C., Guglielmetti, M., Godos, J., Del Bo', C., et al. (2020) · Advances in Nutrition · doi:10.1093/advances/nmaa006 · Cited by 164 · see citing works
Low-carbohydrate diets and cardiometabolic health: the importance of carbohydrate quality over quantity
Sievenpiper, J. L. (2020) · Nutrition Reviews · doi:10.1093/nutrit/nuz082 · Cited by 144 · see citing works
“In systematic reviews and metaanalyses of randomized trials, the early improvements in glycemic control seen at 6 months were not found to be sustained at 12 months in people with diabetes.(22) Improvements seen in triglycerides and high-density lipoprotein cholesterol have also been shown to come at the expense of in…”
Background
5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2026
Bajaj, M. S., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Early, K. B., ChallaSivaKanaka, S., Echouffo-Tcheugui, J. B., et al. (2025) · Diabetes Care · doi:10.2337/dc26-s005 · Cited by 178 · see citing works
The Low-Carbohydrate Diet: Short-Term Metabolic Efficacy Versus Longer-Term Limitations
Barber, T. M., Hanson, P., Kabisch, S., Pfeiffer, A. F. H., & Weickert, M. O. (2021) · Nutrients · doi:10.3390/nu13041187 · Cited by 110 · see citing works
“HCD in adults with T2D, the proportion of daily energy provided by carbohydrate intake was not an important factor in the response to dietary management [37].”
Background
Effect of a very low-carbohydrate ketogenic diet vs recommended diets in patients with type 2 diabetes: a meta-analysis
Rafiullah, M., Musambil, M., & David, S. K. (2022) · Nutrition Reviews · doi:10.1093/nutrit/nuab040 · Cited by 86 · see citing works
Effectiveness of Medicinal Plants for Glycaemic Control in Type 2 Diabetes: An Overview of Meta-Analyses of Clinical Trials
Willcox, M. L., Elugbaju, C., Al-Anbaki, M., Lown, M. T., & Graz, B. (2021) · Frontiers in Pharmacology · doi:10.3389/fphar.2021.777561 · Cited by 79 · see citing works
2023 Clinical Practice Guidelines for Diabetes Management in Korea: Full Version Recommendation of the Korean Diabetes Association
Moon, J. S., Kang, S., Choi, J. H., Lee, K. A., Moon, J. H., Chon, S., Kim, D. J., Kim, H. J., Seo, J. A., Kim, M. K., et al. (2024) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2024.0249 · Cited by 76 · see citing works
What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss
Unwin, D., Delon, C., Unwin, J., Tobin, S., & Taylor, R. (2023) · BMJ Nutrition Prevention & Health · doi:10.1136/bmjnph-2022-000544 · Cited by 75 · see citing works
Embracing complexity: making sense of diet, nutrition, obesity and type 2 diabetes
Forouhi, N. G. (2023) · Diabetologia · doi:10.1007/s00125-023-05873-z · Cited by 79 · see citing works
Nutritional basis of type 2 diabetes remission
Taylor, R., Ramachandran, A., Yancy, W. S., & Forouhi, N. G. (2021) · BMJ · doi:10.1136/bmj.n1449 · Cited by 71 · see citing works
Carbohydrate intake and risk of metabolic syndrome: A dose–response meta-analysis of observational studies
Liu, Y., Wu, Q., Xia, Y., Zhang, J., Jiang, Y., Chang, Q., & Zhao, Y. (2019) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2019.09.003 · Cited by 64 · see citing works
Efficacy of different dietary patterns on lowering of blood pressure level: an umbrella review.
Sukhato, K., Akksilp, K., Dellow, A., Vathesatogkit, P., & Anothaisintawee, T. (2020) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqaa252 · Cited by 38 · see citing works
Low carbohydrate dietary approaches for people with type 2 diabetes-a narrative review
Wheatley, S. D., Deakin, T. A., Arjomandkhah, N. C., Hollinrake, P. B., & Reeves, T. E. (2021) · Frontiers in Nutrition · doi:10.3389/fnut.2021.687658 · Cited by 50 · see citing works
Comprehensive Approach to Medical Nutrition Therapy in Patients with Type 2 Diabetes Mellitus: From Diet to Bioactive Compounds
Barrea, L., Vetrani, C., Verde, L., Frías-Toral, E., Ceriani, F., Cernea, S., Docimo, A., Graziadio, C., Tripathy, D., Savastano, S., et al. (2023) · Antioxidants · doi:10.3390/antiox12040904 · Cited by 55 · see citing works
“, choosing non-starchy vegetables, reducing sugars and refined grains, and increasing whole foods consumption instead of highly processed foods) [79,80].”
Background
Low-carbohydrate diets and type 2 diabetes treatment: a meta-analysis of randomized controlled trials
Silverii, G. A., Botarelli, L., Dicembrini, I., Girolamo, V., Santagiuliana, F., Monami, M., & Mannucci, E. (2020) · Acta Diabetologica · doi:10.1007/s00592-020-01568-8 · Cited by 47 · see citing works
“Again, these results are in line with those of previous meta-analyses [12, 13, 32].”
BackgroundResult
Comparison of the Effectiveness of Low Carbohydrate Versus Low Fat Diets, in Type 2 Diabetes: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Apekey, T. A., Maynard, M. J., Kittana, M., & Kunutsor, S. K. (2022) · Nutrients · doi:10.3390/nu14204391 · Cited by 48 · see citing works
Diet in the management of type 2 diabetes: umbrella review of systematic reviews with meta-analyses of randomised controlled trials
Szczerba, E., Barbaresko, J., Schiemann, T., Stahl‐Pehe, A., Schwingshackl, L., & Schlesinger, S. (2023) · BMJ Medicine · doi:10.1136/bmjmed-2023-000664 · Cited by 47 · see citing works
Very low carbohydrate (ketogenic) diets in type 2 diabetes: A systematic review and meta‐analysis of randomized controlled trials
Parry‐Strong, A., Wright‐McNaughton, M., Weatherall, M., Hall, R. M., Coppell, K. J., Barthow, C. A., & Krebs, J. D. (2022) · Diabetes Obesity and Metabolism · doi:10.1111/dom.14837 · Cited by 42 · see citing works
“Therefore, the value of VLC/KD for weight loss, glycaemic control and CVD risk in these groups is uncertain.(13,14,25,26) This study aimed to estimate the effect of VLC/KD compared with diets higher in carbohydrate, assessed by meta-analysis of randomized controlled trials (RCTs) in people with pre-diabetes or T2D, on…”
Background
Gut Microbiome Activity Contributes to Prediction of Individual Variation in Glycemic Response in Adults
Tily, H., Patridge, E. V., Cai, Y., Gopu, V., Gline, S., Genkin, M., Lindau, H., Sjue, A., Slavov, I., Perlina, A., et al. (2021) · Diabetes Therapy · doi:10.1007/s13300-021-01174-z · Cited by 42 · see citing works
Type 2 Diabetes and Dietary Carbohydrate Intake of Adolescents and Young Adults: What Is the Impact of Different Choices?
Bonsembiante, L., Targher, G., & Maffeis, C. (2021) · Nutrients · doi:10.3390/nu13103344 · Cited by 51 · see citing works
“This finding suggests that the proportion of different macronutrients (and carbohydrates) in the diet seems to be less important than their quality [61].”
Background
2025 Clinical Practice Guidelines for Diabetes Management in Korea: Recommendation of the Korean Diabetes Association
Kang, S., Kang, S. M., Choi, J. H., Ko, S., Koo, B. K., Kwon, H.-S., Kim, M. K., Kim, S. Y., Kim, S., Kim, Y., et al. (2025) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2025.0469 · Cited by 42 · see citing works
Diet, Diabetes Status, and Personal Experiences of Individuals with Type 2 diabetes Who Self-Selected and Followed a Low Carbohydrate High Fat diet
Webster, C. C., Murphy, T., Larmuth, K., Noakes, T. D., & Smith, J. A. H. (2019) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s227090 · Cited by 33 · see citing works
Remission as an Emerging Therapeutic Target in Type 2 Diabetes in the Era of New Glucose-Lowering Agents: Benefits, Challenges, and Treatment Approaches
Vasdeki, D., Koufakis, T., Tsamos, G., Busetto, L., Zebekakis, P. E., & Kotsa, K. (2022) · Nutrients · doi:10.3390/nu14224801 · Cited by 32 · see citing works
Determining Dietary Patterns to Recommend for Type 2 Diabetes: An Umbrella Review
Whiteley, C., Benton, F., Matwiejczyk, L., & Luscombe‐Marsh, N. D. (2023) · Nutrients · doi:10.3390/nu15040861 · Cited by 33 · see citing works
“Blood pressure was examined in six of the meta-analyses with no significant reductions [44,45,52,55,56,58,62].”
BackgroundResultInfluential
The effects of low-carbohydrate diet on glucose and lipid metabolism in overweight or obese patients with T2DM: a meta-analysis of randomized controlled trials
Tian, W.-D., Cao, S., Guan, Y.-X., Zhang, Z.-H., Liu, Q., Ju, J., Xi, R.-X., & Bai, R. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1516086 · Cited by 26 · see citing works
Low and reduced carbohydrate diets: challenges and opportunities for type 2 diabetes management and prevention
Churuangsuk, C., Lean, M. E. J., & Combet, E. (2020) · Proceedings of The Nutrition Society · doi:10.1017/s0029665120000105 · Cited by 31 · see citing works
“More importantly, the difference in HbA1c reduction between the two diets is of unclear clinical importance, with a majority of RCT included in those meta-analyses with high risk of bias((102,103)).”
Background
Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults: A Clinical Practice Guideline From the American College of Lifestyle Medicine
Rosenfeld, R. M., Grega, M. L., Karlsen, M. C., Dabrh, A. M. A., Aurora, R. N., Bonnet, J. P., Donnell, L., Fitzpatrick, S. L., Frates, E. P., Joy, E. A., et al. (2025) · American Journal of Lifestyle Medicine · doi:10.1177/15598276251325488 · Cited by 31 · see citing works
Lower carbohydrate diets for adults with type 2 diabetes
Singh, M. K., Hung, E. S., Cullum, A., Allen, R. E., Aggett, P. J., Dyson, P. A., Forouhi, N. G., Greenwood, D. C., Pryke, R., Taylor, R., et al. (2021) · British Journal Of Nutrition · doi:10.1017/s0007114521002373 · Cited by 24 · see citing works
The homeoviscous adaptation to dietary lipids (HADL) model explains controversies over saturated fat, cholesterol, and cardiovascular disease risk.
Zinöcker, M., Svendsen, K., & Dankel, S. (2021) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqaa322 · Cited by 22 · see citing works
Management of patients with type 2 diabetes in cardiovascular rehabilitation
Hansen, D., Kränkel, N., Kemps, H., Wilhelm, M., Abreu, A., Pfeiffer, A. F. H., Jordão, A., Cornelissen, V., & Völler, H. (2019) · European Journal of Preventive Cardiology · doi:10.1177/2047487319882820 · Cited by 22 · see citing works
Restricting carbohydrates and calories in the treatment of type 2 diabetes: a systematic review of the effectiveness of ‘low-carbohydrate’ interventions with differing energy levels
Nicholas, A. P., Soto-Mota, A., Lambert, H., & Collins, A. L. (2021) · Journal of Nutritional Science · doi:10.1017/jns.2021.67 · Cited by 23 · see citing works
“This may have masked differences in effect size between interventions and led to an underestimation of the positive impact of carbohydrate restriction on glycaemic control((22,24,25,27,29)).”
Background
Lower carbohydrate and higher fat intakes are associated with higher hemoglobin A1c: findings from the UK National Diet and Nutrition Survey 2008–2016
Churuangsuk, C., Lean, M. E. J., & Combet, E. (2019) · European Journal of Nutrition · doi:10.1007/s00394-019-02122-1 · Cited by 22 · see citing works
Down-regulation of SETD6 protects podocyte against high glucose and palmitic acid-induced apoptosis, and mitochondrial dysfunction via activating Nrf2-Keap1 signaling pathway in diabetic nephropathy
Wang, X., Liu, Q., Kong, D., Long, Z., Guo, Y., Wang, S., Liu, R., & Hai, C. (2020) · Journal of Molecular Histology · doi:10.1007/s10735-020-09904-6 · Cited by 20 · see citing works
Nutritional adequacy of very low- and high-carbohydrate, low saturated fat diets in adults with type 2 diabetes: A secondary analysis of a 2-year randomised controlled trial
Tay, J., Thompson, C. H., Luscombe‐Marsh, N. D., Noakes, M., Buckley, J. D., Wittert, G., & Brinkworth, G. D. (2020) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2020.108501 · Cited by 21 · see citing works
Effect of dietary patterns on cardiovascular risk factors in people with type 2 diabetes. A systematic review and network meta-analysis
Bonekamp, N. E., van Damme, I., Geleijnse, J. M., Winkels, R. M., Visseren, F. L. J., Morris, P. B., & Koopal, C. (2022) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2022.110207 · Cited by 17 · see citing works
Efficacy of long‐term low carbohydrate diets for patients with type 2 diabetes: A systematic review and meta‐analysis
Ichikawa, T., Okada, H., Hironaka, J., Nakajima, H., Okamura, T., Majima, S., Senmaru, T., Ushigome, E., Nakanishi, N., Hamaguchi, M., et al. (2024) · Journal of Diabetes Investigation · doi:10.1111/jdi.14271 · Cited by 17 · see citing works
Carbohydrates: Separating fact from fiction
Blaak, E. E., Riccardi, G., & Cho, L. (2021) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2021.03.025 · Cited by 16 · see citing works
Higher fiber higher carbohydrate diets better than lower carbohydrate lower fiber diets for diabetes management: Rapid review with meta‐analyses
Reynolds, A. N., Lang, J., Brand, A., & Mann, J. (2024) · Obesity Reviews · doi:10.1111/obr.13837 · Cited by 17 · see citing works
“Despite the absence of evidence of long-term benefit of carbohydrate restriction 9 – 12 advice promoting low-carbohydrate diets has remained a fairly consistent feature of dietary guidelines for diabetes albeit with caveats to their use, 13,14 despite a lack of consensus on what a low-carbohydrate…”
Self-citation
Total Diet Replacement Within an Integrated Intensive Lifestyle Intervention for Remission of Type 2 Diabetes: Lessons From DiRECT
Noronha, J. C., Thom, G., & Lean, M. E. J. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.888557 · Cited by 14 · see citing works
“The protocol did not include withdrawal of glucose-lowering medication, so a higher figure is likely, but recent review evidence suggests no special advantage for low carbohydrate diets in diabetes care (25, 26).”
Background
Dietary carbohydrate quality and risk of breast cancer among women
Sasanfar, B., Toorang, F., Mohebbi, E., Zendehdel, K., & Azadbakht, L. (2021) · Nutrition Journal · doi:10.1186/s12937-021-00752-y · Cited by 14 · see citing works
“High carbohydrate consumption especially refined carbohydrates is one of the important issue in the management of type 2 diabetes mellitus [7].”
Background
Effects of Carbohydrate Restriction on Body Weight and Glycemic Control in Individuals with Type 2 Diabetes: A Randomized Controlled Trial of Efficacy in Real-Life Settings
Weber, P., Thomsen, M. N., Skytte, M. J., Samkani, A., Carl, M. H., Astrup, A. V., Frystyk, J., Holst, J. J., Hartmann, B., Madsbad, S., et al. (2022) · Nutrients · doi:10.3390/nu14245244 · Cited by 13 · see citing works
Lower carbohydrate diets for adults with type 2 diabetes
Singh, M. K., Hung, E. S., Cullum, A., Allen, R. E., Aggett, P. J., Dyson, P. A., Forouhi, N. G., Greenwood, D. C., Pryke, R., Taylor, R., et al. (2021) · Diabetic Medicine · doi:10.1111/dme.14674 · Cited by 13 · see citing works
The Effects of Carbohydrate-Restricted Dietary Patterns and Physical Activity on Body Weight and Glycemic Control
Kirkpatrick, C. F., Liday, C., & Maki, K. C. (2020) · Current Atherosclerosis Reports · doi:10.1007/s11883-020-00838-8 · Cited by 12 · see citing works
Papel do Jejum Intermitente e da Dieta Restrita em Carboidratos na Prevenção de Doenças Cardiovasculares em Pacientes Pré-Diabéticos
Khalfallah, M., Elnagar, B., Soliman, S., Eissa, A., & Allaithy, A. M. (2023) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20220606 · Cited by 14 · see citing works
Habitual low carbohydrate high fat diet compared with omnivorous, vegan, and vegetarian diets
Jontez, N. B., Kenig, S., Novak, K. Š., Petelin, A., Pražnikar, Z. J., & Mohorko, N. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1106153 · Cited by 11 · see citing works
Effect of ketogenic diet on blood pressure: A GRADE-Assessed systematic review and meta-analysis of randomized controlled trials
Amini, M. R., Askarpour, M., Ghalandari, H., Gholizadeh, M., & Pouraram, H. (2023) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2023.12.004 · Cited by 11 · see citing works
Enhanced Post-Prandial Glycemic Response Prediction in Type 2 Diabetes with Microbiome Data and Deep Learning
Jeong, K., Moon, S., Rachim, V. P., Song, Y.-J., Cho, Y., & Park, S.-M. (2025) · IEEE journal of biomedical and health informatics · doi:10.1109/jbhi.2025.3602827 · Cited by 10 · see citing works
Evolving Nutritional Therapy for Diabetes Mellitus
Uusitupa, M. I. J., & Schwab, U. (2020) · Nutrients · doi:10.3390/nu12020423 · Cited by 11 · see citing works
Update on Nutrition in Diabetes Management
Reynolds, A. N., & Mann, J. I. (2022) · Medical Clinics of North America · doi:10.1016/j.mcna.2022.03.003 · Cited by 14 · see citing works
Self-citation
Low‐carbohydrate diets in East Asians with type 2 diabetes: A systematic review and meta‐analysis of randomized controlled trials
Hironaka, J., Hamaguchi, M., Ichikawa, T., Nakajima, H., Okamura, T., Majima, S., Senmaru, T., Okada, H., Ushigome, E., Nakanishi, N., et al. (2024) · Journal of Diabetes Investigation · doi:10.1111/jdi.14326 · Cited by 9 · see citing works
“These studies have reported signi ﬁ cant lowering of HbA1c levels in the carbohydrate-restricted group than in the control group (regular, high-carbohydrate, and low-fat diets) within 6 – 12 months but not after 12 – 24 months 3,8,11,13,18 .”
Influential
Relationships between sodium, fats and carbohydrates on blood pressure, cholesterol and HbA1c: an umbrella review of systematic reviews
Breeze, P. R., Sworn, K., McGrane, E., Abraham, S., & Cantrell, A. J. (2024) · BMJ Nutrition Prevention & Health · doi:10.1136/bmjnph-2023-000666 · Cited by 9 · see citing works
The Complex Gene–Carbohydrate Interaction in Type 2 Diabetes: Between Current Knowledge and Future Perspectives
Gorini, F., & Tonacci, A. (2025) · Nutrients · doi:10.3390/nu17142350 · Cited by 10 · see citing works
“…[116,170–174], fasting blood glucose [172–174], and other established cardiometabolic risk factors including LDL cholesterol, non-high-density lipoprotein (HDL) cholesterol, total cholesterol, apolipoprotein B, triglycerides, body weight, BMI, and systolic blood pressure [116,172,173,175,176].”
Low-Carbohydrate Dietary Interventions for Metabolic Control in Individuals With Type 2 Diabetes Mellitus: An Overview of Systematic Reviews
Beretta, M. V., Flores, C., Colameo, G. F., Echabe, L. W., & Busnello, F. M. (2024) · Nutrition Reviews · doi:10.1093/nutrit/nuae123 · Cited by 8 · see citing works
Defining a low carbohydrate diet: Proposal for a standardized consensus of carbohydrate intake (Carb-Cal Model)
Dening, J., & Islam, S. M. S. (2020) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2020.108284 · Cited by 7 · see citing works
Dietary Approaches and Health Outcomes: An Evidence Analysis Center Scoping Review
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Authors: Korsmo‐Haugen, H., Brurberg, K. G., Mann, J., & Aas, A.
Affiliations: Faculty of Health Sciences, Department of Health, Nutrition and Management Oslo and Akershus University College of Applied Sciences Oslo Norway
Norwegian Institute of Public Health (NO)
University of Otago (NZ)
Oslo University Hospital (NO)
Corresponding author: Aas, Anne‐Marie
ORCID: Brurberg, Kjetil G.
Mann, Jim
Aas, Anne‐Marie
Venue: Diabetes, Obesity and Metabolism
Publisher: Wiley
Published: 2018-09-10
Volume: 21
Issue: 1
Pages: 15-27
ISSN: 1462-8902 (ISSN-L)
1463-1326
DOI: 10.1111/dom.13499
OpenAlex: W2887342172
Cited by: 115
References: 59
Citations by year: 2026: 4 · 2025: 14 · 2024: 10 · 2023: 16 · 2022: 15 · 2021: 23 · 2020: 19 · 2019: 12 · 2018: 1
FWCI: 1.81
Type: journal article
Language: en
Open access: green
hdl.handle.net
Licence: other-oa
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Diabetes Obesity and Metabolism (publishedVersion)
PubMed (publishedVersion)
NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
Topics: Health Sciences › Medicine › Physiology › Diet and metabolism studies
Health Sciences › Medicine › Physiology › Dietary Effects on Health
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords: type 2 diabetes, low-carbohydrate diet, high-carbohydrate diet, dietary management, glycemic control, HbA1c, triglycerides, lipid profile, body weight, blood pressure, Mediterranean diet, carbohydrate restriction
MeSH terms: Blood Glucose, Body Weight, Diabetes Mellitus, Type 2, Dietary Carbohydrates, Humans, Dyslipidemias, Diet, Carbohydrate-Restricted

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Carbohydrate quantity in the dietary management of type 2 diabetes: A systematic review and meta‐analysis

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