1.
Effects of high-protein diet on glycemic control, insulin resistance and blood pressure in type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials.
Yu, Z, Nan, F, Wang, LY, Jiang, H, Chen, W, Jiang, Y
Clinical nutrition (Edinburgh, Scotland). 2020;(6):1724-1734
Abstract
BACKGROUND Obesity is a well-known risk factor of type 2 diabetes mellitus (T2DM), and it is commonly accompanied by T2DM. It is estimated that almost two thirds of the population with T2DM is also affected by hypertension. Elevated arterial blood pressure would increase the risk for diabetes development. Recently some studies indicated that a high-protein diet was effective for weight loss, and therefore we hypothesized that a high-protein diet could help control blood glucose, mitigate insulin resistance (IR) and improve blood pressure by weight management in T2DM patients. AIM: The study aimed to systematically review the effects of a high-protein diet on glycemic control, IR and blood pressure in T2DM patients. METHODS We searched four electronic databases until May 1st 2018 and included all randomized clinical trials comparing a high-protein diet with other diets. Two reviewers independently identified the trials for inclusion and independently extracted data. Either a fixed- or a random-effects model was used to combine the changes in each outcome from baseline to the end of the intervention. The meta-analysis was performed with RevMan 5.3 software. RESULTS Twelve articles (thirteen studies) including 1138 T2DM patients met our inclusion criteria. Glycemic control was not significantly different between the high-protein diet and control group, with the changes in fasting plasma glucose (FPG) (-0.13 (95% CI (-0.46, 0.19), p = 0.43) mmol/L) and HbA1c% (-0.05 (95% CI (-0.18, 0.08, p = 0.92))) from baseline to the end of intervention. However, the difference in IR between the two groups was statistically significant. Most changes in lipids profiles were favorable. The changes in HDL, LDL, TC, and TG were +0.03 (95% CI (-0.04,0.11), p = 0.35) mmol/L, -0.10 (95% CI (-0.18, -0.02), p = 0.02) mmol/L, -0.21 (95% CI (-0.31, -0.12), p < 0.01) mmol/L and -0.19 (95% CI (-0.33, -0.05), p < 0.01) mmol/L, respectively. The result of HOMA-IR was -0.27 (95% CI (-0.47, -0.06), p < 0.01). Additionally, the difference in blood pressure in terms of systolic blood pressure (-0.57 (95% CI (-2.45, 1.32), p = 0.55)) and diastolic blood pressure (-0.73 (95% CI (-2.48, 1.02), p = 0.41)) was not significant. CONCLUSION This review showed that a high-protein diet does not significantly improve glycemic control and blood pressure, but can lower LDL, TC, TG and HOMA-IR levels in T2DM patients. Further studies are needed to clarify the effects of a high-protein diet on glycemic control, IR and blood pressure control in T2DM patients.
2.
Decreased insulin sensitivity and abnormal glucose metabolism start in preadolescence in low-birth-weight children-Meta-analysis and systematic review.
Xu, Y, Chen, S, Yang, H, Gong, F, Wang, L, Jiang, Y, Yan, C, Zhu, H, Pan, H
Primary care diabetes. 2019;(5):391-398
Abstract
AIMS: Our meta-analysis aimed to analyze glucose and insulin abnormalities in small-for-gestational-age (SGA) or low-birth-weight (LBW) young people. METHODS Our data were collected from several databases, including PubMed, AMED and so on. Cohort studies in English were included. SGA or LBW participants comprised the case group, while non-SGA or non-LBW participants comprised the control group. All subjects were younger than 45 years old. RESULTS Sixteen studies and 10,060 subjects were included in this meta-analysis. The case group showed higher levels of oral glucose tolerance test (OGTT) 2-h glucose (mean difference (MD) = 0.32 mmol/L, 95% confidence interval (CI) 0.13-0.52 mmol/L, P = 0.0009) and fasting and OGTT 2-h insulin than the control group (respectively, MD = 7.47 pmol/L, 95% CI 1.77-13.17 pmol/L, P = 0.01 and MD = 105.55 pmol/L, 95% CI 65.43-145.66 pmol/L, P < 0.00001). In the preadolescence group (maximum age or 95% CI of age ≤10 years old), the OGTT 2-h glucose in the case group had an upward tendency compared to the control group, while the OGTT 2-h insulin in the case group was significantly higher than that in the control group (MD = 118.51 pmol/L, 95% CI 56.80-180.22 pmol/L, P = 0.0002). In the adolescence group (minimum age >10 years old and maximum age≤20 years old or 10 years old<95% CI of age≤20 years old), subjects in the case group showed significantly higher fasting and OGTT 2-h glucose than did the control group (respectively, MD = 0.14 mmol/L, 95% CI 0.04-0.24 mmol/L, P = 0.005 and MD = 0.40 mmol/L, 95% CI 0.08-0.71 mmol/L, P = 0.01). However, fasting and OGTT 2-h insulin in the case group were not significantly different from those in the control group (respectively, MD = 6.56 pmol/L, 95% CI -4.54-17.65 pmol/L, P = 0.25 and MD = 65.89 pmol/L, 95% CI -50.00-181.78 pmol/L, P = 0.27). CONCLUSIONS Decreased insulin sensitivity and abnormal glucose metabolism began early in preadolescence. Furthermore, glucose tolerance was worse in adolescence. LBW or SGA status affects glucose metabolism and insulin sensitivity beginning in preadolescence.