Improving type 2 diabetes mellitus glycaemic control through lifestyle modification implementing diet intervention: a systematic review and meta-analysis

  • Laura García-MolinaEmail author
  • Anne-Mary Lewis-Mikhael
  • Blanca Riquelme-Gallego
  • Naomi Cano-Ibáñez
  • María-Jesús Oliveras-López
  • Aurora Bueno-Cavanillas



Type 2 diabetes mellitus represents a significant health problem. Many studies have reported that intensive nutritional intervention by itself or in addition to medications is the best method to improve glycaemic control in type 2 diabetes mellitus. However, in clinical practice, dietary education is not implemented as an integral part in the management of type 2 diabetes mellitus. The purpose of this systematic review and meta-analysis is to analyse the scientific evidence concerning the role of nutritional intervention in the glycaemic control of type 2 diabetes mellitus.


We searched Pubmed, Scopus, Cochrane Library and Web of Science databases from inception till May 2019 for randomised controlled trials (RCTs) that include dietary interventions in the management of patients with type 2 diabetes mellitus.


A total of 28 studies were included. Our results demonstrated that lifestyle interventions significantly lowered glycosylated haemoglobin (HbA1c) levels compared to the usual care for patients with type 2 diabetes mellitus, overall weighted mean difference, WMD = − 0.51 (− 0.67, − 0.35). Strategies combining individualized and group-based activities were the most effective, WMD = − 0.95 (− 1.24, − 0.66). Most of stratified analyses did not totally resolve heterogeneity, but improvement in HbA1c levels has been consistently observed.


The available evidence from RCTs shows that lifestyle intervention is more effective than the standard care regarding the glycaemic control of type 2 diabetic patients, particularly when there is a weight loss. It is time to translate this evidence to the primary health care practice. The protocol of the present systematic review was registered in PROSPERO, registration number CRD42018090469.


Diet Glycaemic control Lifestyle intervention Meta-analysis Systematic review Type 2 diabetes mellitus 



Body mass index


Glycosylated haemoglobin


Randomised clinical trials


Weighted mean difference



The first author would like to acknowledge support by the CIBER Epidemiología y Salud Pública (CIBERESP/CB06/02/1014). The authors especially thank the co-authors for their collaboration and effort in this systematic review and meta-analysis.


The research leading to these results has received funding from the CIBER Epidemiología y Salud Pública (CIBERESP/CB06/02/1014).

Compliance with ethical standards

Conflict of interest

The authors declare that there is no duality of interest associated with this manuscript.

Supplementary material

394_2019_2147_MOESM1_ESM.docx (545 kb)
Supplementary material 1 (DOCX 544 kb)


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© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Preventive Medicine and Public HealthUniversity of GranadaGranadaSpain
  2. 2.CIBER Epidemiología y Salud Pública (CIBERESP)MadridSpain
  3. 3.Department of Obstetrics and GynecologyMcMaster UniversityHamiltonCanada
  4. 4.High Institute of Pubic Health, Alexandria UniversityAlexandriaEgypt
  5. 5.Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO)GranadaSpain
  6. 6.Department of Molecular Biology and Biochemical EngineeringUniversity Pablo de OlavideSevilleSpain
  7. 7.Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Servicio Andaluz de Salud/Universidad de GranadaGranadaSpain

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