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
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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 (body mass index), 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, systolic blood pressure (dose-response), and CRP (P<0.05), but not blood insulin, HDL-C, waist circumference, or diastolic 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, blood pressure, 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.
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Other studies demonstrated A1C reductions of 0.15% to 0.5% with glycemic index and glycemic load.
“Studies have found mixed results regarding the effect of glycemic index and glycemic load on fasting glucose levels and A1C, with one systematic review finding no significant impact on A1C (160) while others demonstrated A1C reductions of 0.15% (158) to 0.5% (161,162).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [162]
Studies have found mixed results regarding the effect of glycemic index and glycemic load on fasting glucose levels and A1C.
“Studies have found mixed results regarding the effect of glycemic index and glycemic load on fasting glucose levels and A1C, with one systematic review finding no significant impact on A1C (160) while others demonstrated A1C reductions of 0.15% (158) to 0.5% (161,162).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [162]
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Comparison of a low-glycemic index vs standard diabetic diet
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“Since this eating pattern provides benefits in improving glycemic control, dyslipidemia, blood pressure, and inflammation in patients with diabetes mellitus [49], it is potentially an important dietary pattern for women with PCOS as well.”
Background
- Authors
- Chiavaroli, L., Lee, D., Ahmed, A., Cheung, A., Khan, T. A., Blanco, S., Mejia, Mirrahimi, A., Jenkins, D. J. A., Livesey, G., Wolever, T. M. S., Rahelić, D., Kahleová, H., Salas-Salvadó, J., Kendall, C. W. C., & Sievenpiper, J. L.
- Affiliations
- St. Michael's Hospital (CA)
- University of Toronto (CA)
- University of Zagreb (HR)
- Physicians Committee for Responsible Medicine (US)
- Corresponding author
- Sievenpiper, John L
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2021-08-04
- Volume
- 374
- Pages
- n1651
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC8336013
- OpenAlex
- W3188491684
- Cited by
- 215
- References
- 100
- Citations by year
- 2026: 29 · 2025: 51 · 2024: 50 · 2023: 38 · 2022: 41 · 2021: 5
- FWCI
- 4.46
- Type
- journal article
- Language
- en
- Update notices
- correction (2021-08-26)
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Rovira & Virgili repository (submittedVersion, cc-by)
- Funders
- U.S. Department of Agriculture
- American Association for the Advancement of Science
- Amgen
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- Sanofi
- PepsiCo
- General Mills
- Arizona State University
- Danone
- Almond Board of California
- Dairy Farmers of Canada
- United Soybean Board
- Canadian Cardiovascular Society
- Diabetes Canada (129920)
- European Food Safety Authority
- Glycemic Index Foundation
- Canadian Nutrition Society
- Canola Council of Canada
- Alberta Pulse Growers Commission
- Loblaw Companies Limited
- Peanut Institute
- Mylan
- Physicians Committee for Responsible Medicine
- National Honey Board
- Physicians' Services Incorporated Foundation
- Royal Society
- Diabetes UK
- Society for Endocrinology
- British Nutrition Foundation
- European Commission
- Generalitat de Catalunya
- University of Toronto
- Institució Catalana de Recerca i Estudis Avançats
- Novo Nordisk
- Mitacs
- Hospital for Sick Children
- European Association for the Study of Diabetes
- Instituto Danone
- International Nut and Dried Fruit Council
- International Sweeteners Association
- Merck Sharp and Dohme
- Health Canada
- Canadian Institutes of Health Research (129920)
- Agriculture and Agri-Food Canada
- Banting and Best Diabetes Centre, University of Toronto
- Medical Research Council
- Instituto de Salud Carlos III
- Obesity Canada
- Ontario Ministry of Research and Innovation
- Institute of Nutrition, Metabolism and Diabetes (129920)
- Eurostars
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- low glycemic index diet, type 1 diabetes, type 2 diabetes, glycemic control, HbA1c, cardiometabolic risk factors, LDL cholesterol, triglycerides, blood pressure, body weight, C-reactive protein, inflammation, nutritional therapy, dose-response relationship, dietary habits, serum lipids, adiposity
- MeSH terms
- Glycemic Load, Cardiometabolic Risk Factors, Glycemic Control, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Diet, Diabetic, Humans, Glycemic Index
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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