Effect of Low/Very Low-Calorie and Other Special Diets on Anthropometric and Cardio-Metabolic Parameters of Diabetes Mellitus Patients: A Systematic Review and Meta-Analysis

Authors

DOI:

https://doi.org/10.55489/njcm.161020255875

Keywords:

Non-communicable disease, VLCD, Diabetes mellitus, Cardiovascular disease, Lipid metabolism

Abstract

Introduction and Methodology: This systematic review and meta-analysis, following PRISMA guidelines and registered in PROSPERO (CRD42025645593), searched Embase, Scopus, PubMed, Web of Sciences and Google Scholar for studies on low-calorie or very-low-calorie or other special diets (VLC/KD) in diabetes mellitus (DM) patients.

Results: From 16 RCTs involving 1232 patients, the meta-analysis found reductions with standardised mean difference in weight (-0.59; 95% CI, -1.05: -0.13), waist (-0.72; 95% CI, -1.80: 0.37), BMI (-0.93; 95% CI, -1.56; -0.29), Hba1c (-0.67; 95% CI, -0.94: -0.40), fasting (-0.82; 95% CI, -1.35: -0.29) and post-prandial blood sugar (-0.45; 95% CI, -4.06: 3.16), Total cholesterol (-0.37; 95% CI, -0.76: 0.03), LDL cholesterol (-0.16; 95% CI, -0.45: 0.14), HDL cholesterol (0.19; 95% CI, -0.03: 0.41), systolic blood pressure (-0.55; 95% CI, -0.89: -0.22), and diastolic blood pressure (-0.52; 95% CI, -0.92: -0.13) after a long-term intake of low/very-low calorie or other special diets. High heterogeneity (I² >50%) was observed in most outcomes, warranting cautious interpretation.

Conclusions: These results support incorporating high-fibre, low-glycemic index foods and Monounsaturated Fatty Acids (MUFA) over Saturated Fatty Acids in energy-balanced diets for DM management.

References

Alarim RA, Alasmre FA, Alotaibi HA, Alshehri MA, Hussain SA. Effects of the Ketogenic Diet on Glycemic Control in Diabetic Patients: Meta-Analysis of Clinical Trials. Cureus. 2020 Oct 5;12(10):e10796. DOI: https://doi.org/10.7759/cureus.10796 PMid:33163300 PMCid:PMC7641470

Raksa Karolina, Pawlina Mateusz, Ziętara Karolina, Lewkowicz Martyna, Nowakowska Katarzyna, Raczkiewicz Przemysław. The ketogenic diet in the treatment of diabetes type 2. Journal of Education, Health and Sport. 2022;12(7):92-98. DOI: https://doi.org/10.12775/JEHS.2022.12.07.009

Tinguely D, Gross J, Kosinski C. Efficacy of Ketogenic Diets on Type 2 Diabetes: a Systematic Review. Curr Diab Rep. 2021 Aug 27;21(9):32. DOI: https://doi.org/10.1007/s11892-021-01399-z PMid:34448957 PMCid:PMC8397683

Wong K, Raffray M, Roy-Fleming A, Blunden S, Brazeau AS. Ketogenic Diet as a Normal Way of Eating in Adults With Type 1 and Type 2 Diabetes: A Qualitative Study. Can J Diabetes. 2021 Mar;45(2):137-143.e1. DOI: https://doi.org/10.1016/j.jcjd.2020.06.016 PMid:33039330

Huntriss R, Campbell M, Bedwell C. The interpretation and effect of a low-carbohydrate diet in the management of type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials. Eur J Clin Nutr. 2018;72(3):311-325. DOI: https://doi.org/10.1038/s41430-017-0019-4 PMid:29269890

Van Zuuren EJ, Fedorowicz Z, Kuijpers T, Pijl H. Effects of low-carbohydrate- compared with low-fat-diet interventions on metabolic control in people with type 2 diabetes: a systematic review including GRADE assessments. Am J Clin Nutr. 2018;108(2):300-331. DOI: https://doi.org/10.1093/ajcn/nqy096 PMid:30007275

Sainsbury E, Kizirian NV, Partridge SR, Gill T, Colagiuri S, Gibson AA. Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract. 2018 May;139:239-252. DOI: https://doi.org/10.1016/j.diabres.2018.02.026 PMid:29522789

Snorgaard O, Poulsen GM, Andersen HK, Astrup A. Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes. BMJ Open Diabetes Res Care. 2017;5(1):e000354. DOI: https://doi.org/10.1136/bmjdrc-2016-000354 PMid:28316796 PMCid:PMC5337734

Singh M, Hung ES, Cullum A, et al. Lower-carbohydrate diets for adults with type 2 diabetes. Br J Nutr. 2021;127(9):1352-1357. DOI: https://doi.org/10.1017/S0007114521002373 PMid:34719409

Alonso-Domínguez R, García-Ortiz L, Patino-Alonso MC, Sánchez-Aguadero N, Gómez-Marcos MA, Recio-Rodríguez JI. Effectiveness of a multifactorial intervention in increasing adherence to the Mediterranean diet among patients with diabetes mellitus type 2: a controlled and randomized study (EMID study). Nutrients. 2019 Jan 14;11(1):162. DOI: https://doi.org/10.3390/nu11010162 PMid:30646500 PMCid:PMC6357113

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;372:n71. DOI: https://doi.org/10.1136/bmj.n71 PMid:33782057 PMCid:PMC8005924

Anyiam O, Phillips B, Quinn K, Wilkinson D, Smith K, Atherton P, Idris I. Metabolic effects of very-low-calorie diet, Semaglutide, or combination of the two, in individuals with type 2 diabetes mellitus. Clinical Nutrition. 2024 Aug 1;43(8):1907-1913. DOI: https://doi.org/10.1016/j.clnu.2024.06.034 PMid:38996661

Li S, Lin G, Chen J, Chen Z, Xu F, Zhu F, Zhang J, Yuan S. The effect of periodic ketogenic diet on newly diagnosed overweight or obese patients with type 2 diabetes. BMC Endocr Disord. 2022 Feb 3;22(1):34. DOI: https://doi.org/10.1186/s12902-022-00947-2 PMid:35115003 PMCid:PMC8811985

Umphonsathien M, Rattanasian P, Lokattachariya S, Suansawang W, Boonyasuppayakorn K, Khovidhunkit W. Effects of intermittent very-low-calorie diet on glycemic control and cardiovascular risk factors in obese patients with type 2 diabetes mellitus: A randomized controlled trial. Journal of diabetes investigation. 2022 Jan;13(1):156-166. DOI: https://doi.org/10.1111/jdi.13619 PMid:34176234 PMCid:PMC8756303

Durrer C, McKelvey S, Singer J, Batterham AM, Johnson JD, Gudmundson K, Wortman J, Little JP. A randomized controlled trial of pharmacist-led therapeutic carbohydrate and energy restriction in type 2 diabetes. Nature Communications. 2021 Sep 10;12(1):5367. DOI: https://doi.org/10.1038/s41467-021-25667-4 PMid:34508090 PMCid:PMC8433183

Moriconi E, Camajani E, Fabbri A, Lenzi A, Caprio M. Very-low-calorie ketogenic diet as a safe and valuable tool for long-term glycemic management in patients with obesity and type 2 diabetes. Nutrients. 2021 Feb 26;13(3):758. DOI: https://doi.org/10.3390/nu13030758 PMid:33652834 PMCid:PMC7996853

Brown A, Dornhorst A, McGowan B, Omar O, Leeds AR, Taheri S, Frost GS. Low-energy total diet replacement intervention in patients with type 2 diabetes mellitus and obesity treated with insulin: a randomized trial. BMJ Open Diabetes Research and Care. 2020 Jan 1;8(1):e001012. DOI: https://doi.org/10.1136/bmjdrc-2019-001012 PMid:32049634 PMCid:PMC7039597

Ren M, Zhang H, Qi J, Hu A, Jiang Q, Hou Y, Feng Q, Ojo O, Wang X. An almond-based low carbohydrate diet improves depression and glycometabolism in patients with type 2 diabetes through modulating gut microbiota and GLP-1: a randomized controlled trial. Nutrients. 2020 Oct 3;12(10):3036. DOI: https://doi.org/10.3390/nu12103036 PMid:33022991 PMCid:PMC7601479

Skytte MJ, Samkani A, Petersen AD, Thomsen MN, Astrup A, et al. A carbohydrate-reduced high-protein diet improves HbA1c and liver fat content in weight stable participants with type 2 diabetes: a randomised controlled trial. Diabetologia. 2019 Nov;62(11):2066-2078. DOI: https://doi.org/10.1007/s00125-019-4956-4 PMid:31338545

Carter S, Clifton PM, Keogh JB. Effect of intermittent compared with continuous energy-restricted diet on glycemic control in patients with type 2 diabetes: a randomized noninferiority trial. JAMA Network Open. 2018 Jul 6;1(3): e180756-e180756. DOI: https://doi.org/10.1001/jamanetworkopen.2018.0756 PMid:30646030 PMCid:PMC6324303

Tay J, Thompson CH, Luscombe‐Marsh ND, Wycherley TP, et al. Effects of an energy‐restricted low‐carbohydrate, high unsaturated fat/low saturated fat diet versus a high‐carbohydrate, low‐fat diet in type 2 diabetes: a 2‐year randomized clinical trial. Diabetes, Obesity and Metabolism. 2018 Apr;20(4):858-871. DOI: https://doi.org/10.1111/dom.13164 PMid:29178536

Wang LL, Wang Q, Hong Y, Ojo O, Jiang Q, Hou YY, Huang YH, Wang XH. The effect of a low-carbohydrate diet on glycemic control in patients with type 2 diabetes mellitus. nutrients. 2018 May 23;10(6):661. DOI: https://doi.org/10.3390/nu10060661 PMid:29882884 PMCid:PMC6024764

Saslow LR, Mason AE, Kim S, Goldman V, Ploutz-Snyder R, et al. An online intervention comparing a very low-carbohydrate ketogenic diet and lifestyle recommendations versus a plate method diet in overweight individuals with type 2 diabetes: a randomized controlled trial. J Med Internet Res. 2017 Feb 13;19(2):e36. DOI: https://doi.org/10.2196/jmir.5806 PMid:28193599 PMCid:PMC5329646

Goday A, Bellido D, Sajoux I, Crujeiras AB, et al. Short-term safety, tolerability and efficacy of a very low-calorie-ketogenic diet interventional weight loss program versus hypocaloric diet in patients with type 2 diabetes mellitus. Nutrition & diabetes. 2016 Sep;6(9):e230. DOI: https://doi.org/10.1038/nutd.2016.36 PMid:27643725 PMCid:PMC5048014

Snel M, Gastaldelli A, Ouwens DM, Hesselink MK, Schaart G, et al. Effects of adding exercise to a 16-week very low-calorie diet in obese, insulin-dependent type 2 diabetes mellitus patients. J Clin Endocrinol Metab. 2012 Jul 1;97(7):2512-2520. DOI: https://doi.org/10.1210/jc.2011-3178 PMid:22569236

Wing RR, Blair E, Marcus M, Epstein LH, Harvey J. Year-long weight loss treatment for obese patients with type II diabetes: does including an intermittent very-low-calorie diet improve outcome? Am J Med. 1994 Oct 1;97(4):354-362. DOI: https://doi.org/10.1016/0002-9343(94)90302-6 PMid:7942937

Dashti HM, Mathew TC, Al-Zaid NS. Efficacy of low-carbohydrate ketogenic diet in the treatment of type 2 diabetes. Med Princ Pract. 2021 Jun 30;30(3):223-235. DOI: https://doi.org/10.1159/000512142 PMid:33040057 PMCid:PMC8280429

Rafiullah M, Musambil M, David SK. Effect of a very low-carbohydrate ketogenic diet vs recommended diets in patients with type 2 diabetes: a meta-analysis. Nutrition Reviews. 2022 Mar;80(3):488-502. DOI: https://doi.org/10.1093/nutrit/nuab040 PMid:34338787

Lichtash C, Fung J, Ostoich KC, Ramos M. Therapeutic use of intermittent fasting and ketogenic diet as an alternative treatment for type 2 diabetes in a normal weight woman: a 14-month case study. BMJ Case Rep. 2020 Jul 7;13(7):e234223. DOI: https://doi.org/10.1136/bcr-2019-234223 PMid:32641437 PMCid:PMC7342268

Schneider S, Biggerstaff DL, Barber TM. Helpful or harmful? The impact of the ketogenic diet on eating disorder outcomes in type 1 diabetes mellitus. Expert Rev Endocrinol Metab. 2022 Jul;17(4):319-331. DOI: https://doi.org/10.1080/17446651.2022.2089112 PMid:35748612

Zhou C, Wang M, Liang J, He G, Chen N. Ketogenic Diet Benefits to Weight Loss, Glycemic Control, and Lipid Profiles in Overweight Patients with Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled trials. Int J Environ Res Public Health. 2022 Aug 22;19(16):10429. DOI: https://doi.org/10.3390/ijerph191610429 PMid:36012064 PMCid:PMC9408028

Versha, Jangra Y, Sharma L, Meher A, Tare H. The Role of Ketogenic Diet in the Management of Diabetes and Overcome its Effect: A Review. Int J Pharm Qual Assur. 2023;14(1):220-225. DOI: https://doi.org/10.25258/ijpqa.14.1.38

Kumar S, Behl T, Sachdeva M, Sehgal A, Kumari S, Kumar A, Kaur G, Yadav HN, Bungau S. Implicating the effect of the ketogenic diet as a preventive measure to obesity and diabetes mellitus. Life sciences. 2021 Jan 1;264:118661. DOI: https://doi.org/10.1016/j.lfs.2020.118661 PMid:33121986

Choi YJ, Jeon SM, Shin S. Impact of a ketogenic diet on metabolic parameters in patients with obesity or overweight and with or without type 2 diabetes: a meta-analysis of randomized controlled trials. Nutrients. 2020 Jul 6;12(7):2005. DOI: https://doi.org/10.3390/nu12072005 PMid:32640608 PMCid:PMC7400909

Myette-Côté É, Durrer C, Neudorf H, Bammert TD, Botezelli JD, Johnson JD, DeSouza CA, Little JP. The effect of a short-term low-carbohydrate, high-fat diet with or without postmeal walks on glycemic control and inflammation in type 2 diabetes: a randomized trial. Am J Physiol Regul Integr Comp Physiol. 2018 Dec 1;315(6):R1210-R1219. DOI: https://doi.org/10.1152/ajpregu.00240.2018 PMid:30303707 PMCid:PMC6734060

Lee YM, Kim SA, Lee IK, Kim JG, Park KG, Jeong JY, Jeon JH, Shin JY, Lee DH. Effect of brown rice based vegan diet and conventional diabetic diet on glycemic control of patients with type 2 diabetes: a 12-week randomized clinical trial. PloS one. 2016 Jun 2;11(6):e0155918. DOI: https://doi.org/10.1371/journal.pone.0155918 PMid:27253526 PMCid:PMC4890770

Vitale M, Masulli M, Calabrese I, Rivellese AA, et al. Impact of a Mediterranean dietary pattern and its components on cardiovascular risk factors, glucose control, and body weight in people with type 2 diabetes: a real-life study. Nutrients. 2018 Aug 10;10(8):1067. DOI: https://doi.org/10.3390/nu10081067 PMid:30103444 PMCid:PMC6115857

Gardner CD, Landry MJ, Perelman D, Petlura C, et al. Effect of a ketogenic diet versus Mediterranean diet on glycated hemoglobin in individuals with prediabetes and type 2 diabetes mellitus: The interventional Keto-Med randomized crossover trial. Am J Clin Nutr. 2022 Sep 2;116(3):640-652. DOI: https://doi.org/10.1093/ajcn/nqac154. Erratum in: Am J Clin Nutr. 2022 Dec 19;116(6):1904. DOI: https://doi.org/10.1093/ajcn/nqac279. PMID: 35641199; PMCID: PMC9437985

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2025-10-01

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Gupta B, Singh R, Verma N, Gupta K, Datta G, Mittal A. Effect of Low/Very Low-Calorie and Other Special Diets on Anthropometric and Cardio-Metabolic Parameters of Diabetes Mellitus Patients: A Systematic Review and Meta-Analysis. Natl J Community Med [Internet]. 2025 Oct. 1 [cited 2025 Oct. 1];16(10):1021-36. Available from: https://njcmindia.com/index.php/file/article/view/5875

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Systematic Review/ Meta Analysis

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