Nutrient Intake Order on Metabolic Outcomes in Type 2 Diabetes—A Systematic Review and Meta-analysis

Saldarriaga L., Andrade A. D., Ratan P., Kodalak S., Pasqualotto E., Bovi T. G., ...More

American Diabetes Association 85th Scientific Sessions, Illinois, United States Of America, 21 - 23 June 2025, pp.588, (Full Text)

  • Publication Type: Conference Paper / Full Text
  • Doi Number: 10.2337/db25-588-p
  • City: Illinois
  • Country: United States Of America
  • Page Numbers: pp.588
  • Hacettepe University Affiliated: Yes

Abstract

Introduction and Objective: Non-pharmacological therapies for type 2 diabetes (T2D) require simpler, adaptable recommendations that align with diverse contexts, preferences, and long-term goals. This study aims to evaluate the impact of a carbohydrate-last (CL) strategy compared to carbohydrate-first or unordered (CF) nutrient intake on metabolic parameters in T2D.

Methods: PubMed, EMBASE, and Cochrane Central were systematically searched for randomized controlled trials (RCTs) evaluating nutrient intake order in T2D. Mean difference (MD) with 95% confidence intervals (CI) was used for all outcomes. Heterogeneity was assessed with I² statistics. Statistical analyses were performed using R version 4.2.3.

Results: Seventeen studies involving 389 participants were included, with 114 (29%) in a parallel design and 192 (49%) in a crossover design receiving CL. In the pooled analysis, the CL group had significantly lower postprandial glucose at 120 minutes (MD: -13.00 mg/dL; 95% CI: -21.07, -4.93; p<0.01). Insulin levels at 120 minutes postprandial (MD: -3.90 uIU/mL; 95% CI: -16.85, 9.04; p=0.55) showed no significant differences. The CL group had significantly higher postprandial GLP-1 levels at 120 minutes (MD: 8.21 pmol/L; 95% CI: 2.33, 14.09; p<0.01), while GIP levels at the same time point (MD: 5.79 pmol/L; 95% CI: -6.33, 17.90; p=0.35) showed no significant differences. Gastric emptying half-time in the CL group (MD: 28.14 min; 95% CI: 16.06, 40.23; p<0.01) was significantly delayed. Glycated hemoglobin (HbA1C) levels at the end of the follow-up (MD: -0.16%; 95% CI: -0.31, -0.01; p=0.04) were significantly lower in the CL group.

Conclusion: Carbohydrate-last nutrient intake is associated with improved postprandial glucose profile and HbA1C levels in individuals with T2D. Further research is needed to confirm its sustainability and applicability across diverse populations