A systematic review and meta-analysis of nutrition therapy compared with dietary advice in patients with type 2 diabetes
Open accessAbstract
Background: Despite recommendations, many patients with type 2 diabetes receive dietary advice from nurses or doctors instead of individualized nutrition therapy (INT) that is provided by a dietitian.Objective: We performed a meta-analysis to compare the effect of INT that is provided by a registered dietitian with the effect of dietary advice that is provided by other healthcare professionals.Design: A systematic review was conducted of Cochrane library databases, EMBASE, CINAHL, and MEDLINE in the period 2004-2017 for guidelines, reviews, and randomized controlled trials (RCTs) that assessed the outcomes glycated hemoglobin (HbA1c), weight, body mass index (BMI; in kg/m 2), and LDL cholesterol. Risk of bias and the quality of evidence were assessed according to the Grading of Recommendations Assessment, Development and Evaluation guidelines.Results: We identified 5 RCTs comprising 912 participants in total. In the first year of intervention (at 6 or 12 mo), nutrition therapy compared with dietary advice was followed by a 0.45% (95% CI: 0.36%, 0.53%) lower mean difference in HbA1c, a 0.55 (95% CI: 0.02, 1.1) lower BMI, a 2.1-kg (95% CI: 1.2-, 2.9-kg) lower weight, and a 0.17-mmol/L (95% CI: 0.11-, 0.23-mmol/L) lower LDL cholesterol. No longer-term data were available. Some of the included studies had a potential bias, and therefore, the quality of the evidence was low or moderate. In addition, it was necessary to pool primary and secondary outcomes.Conclusions: INT that is provided by a dietitian compared with dietary advice that is provided by other health professionals leads to a greater effect on HbA1c, weight, and LDL cholesterol. Because of the potential bias, we recommend considering nutrition therapy that is provided by a dietitian as part of lifestyle intervention in type 2 diabetes, but further randomized studies are warranted.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Metformin was particularly effective in people with A1C 6.1% to 6.4%, BMI ≥30 kg/m2, age <60 years, and women with prior gestational diabetes.
“Metformin was particularly effective in persons with A1C 6.1% to 6.4%, BMI ≥30 kg/m2, those aged <60 years, and women with prior GDM.897”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [897]
The Effects of the intervention section reports outcomes for nutrition therapy compared with dietary advice in patients with type 2 diabetes, not metformin. Searches for metformin, prior gestational diabetes, and the specified A1C, BMI, and age subgroups found no passage addressing the claim; page numbers were unavailable in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredUse of organization-approved protocols for insulin and other glucose-lowering medications can help reduce therapeutic inertia and/or reduce the risk of hypoglycemia and hyperglycemia.
“Use of organization-approved protocols for insulin and other glucose-lowering medications can help reduce therapeutic inertia and/or reduce the risk of hypoglycemia and hyperglycemia (12,16 -18,262,263).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [18]
The Discussion reports improved HbA1c after individualized nutrition therapy compared with dietary advice, not the effects of medication protocols. Searches for insulin protocols, therapeutic inertia, and hypoglycemia found no passage in our copy addressing whether such protocols reduce therapeutic inertia or the risk of hypo- or hyperglycemia. The available passages have section labels but no page numbers. (LLM, conf=0.76)
Experimental — accuracy not yet measuredCombination therapy of a GLP-1 receptor agonist with an SU or insulin is associated with an increased risk of hypoglycemia.
“While these agents have also been shown to exert their glucose‐lowering effect in combination with an SU or insulin, this combination therapy is shown to be associated with an increased risk of hypoglycemia, suggesting the rationale for reducing the dose of either partnering agent 23 , 24 .”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [24]
Psychological/behavioral approaches are effective in diabetes management.
“Psychological/behavioral approaches have been shown to be effective in diabetes management 24 , 25 (grade A: 95% agreement).”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [24]
A decreased GFR and the occurrence of albuminuria are independent risk factors for cardiovascular disease.
“A decreased GFR and the occurrence of albuminuria are independent risk factors for cardiovascular disease 24 .”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [24]
The use of fibrates reduces the risk of non-fatal cardiovascular disease in patients with diabetes and dyslipidemia.
“The use of fibrates has been shown to reduce the risk of non‐fatal CVD in patients with diabetes and dyslipidemia 24 , 25 , 26 , 27 , 28 (grade B: 88% agreement).”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [24]
No U-shaped relationship has been shown between alcohol intake and the risk of type 2 diabetes in Asians.
“Drinking alcohol is not recommended as a preventive measure against type 2 diabetes in Asians in whom no U‐shaped relationship has been shown between alcohol intake and the risk of type 2 diabetes 24 .”
From Japanese clinical practice guideline for diabetes 2019 (2020) · cites this paper as [24]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 18 · Cited by 93
Research works printed but not linked: 2
- [5]5. Covidence: Covidence systematic review software [Internet]. Melbourne (Australia): Veritas Health Innovation. Ó2017. Available from: www. covidence.org.
- [9]9. SBU. Patientutbildning vid diabetes. En systematisk litteraturo ¨versikt. [Patient education in diabetes. A systematic review of the literature.] Stockholm (Sweden): Statens beredning fo ¨r medicinsk utvärdering [Swedish Council on Technology Assessment in Health Care] (SBU); 2009. p. 1-85 (SBU-rapport nr. 195) (in Swedish).
- Authors
- Møller, G., Andersen, H. K., & Snorgaard, O.
- Affiliations
- University of Copenhagen (DK)
- Bispebjerg Hospital (DK)
- Hvidovre Hospital (DK)
- Corresponding author
- Snorgaard, Ole
- ORCID
- Møller, Grith
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2017-12
- Volume
- 106
- Issue
- 6
- Pages
- 1394-1400
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2765160373
- Cited by
- 93
- References
- 18
- Citations by year
- 2026: 8 · 2025: 5 · 2024: 7 · 2023: 7 · 2022: 10 · 2021: 15 · 2020: 19 · 2019: 12 · 2018: 10
- FWCI
- 2.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Topics
- Health Sciences › Health Professions › Health Information Management › Dietetics, Nutrition, and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 2 diabetes, dietary recommendations, HbA1c, body mass index, weight loss, LDL cholesterol, lifestyle intervention, glycemic control
- MeSH terms
- Body Weight, Counseling, Diabetes Mellitus, Type 2, Female, Health Education, Glycated Hemoglobin, Humans, Cholesterol, LDL, Male, Middle Aged, Nurses, Physicians, Body Mass Index, Outcome Assessment, Health Care, Nutrition Therapy, Nutritionists
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 ›
Are you an author, or do you see a problem with this page? Request a review
