Type of vegetarian diet, obesity and diabetes in adult Indian population Vegetarian diet-induced increase in linoleic acid in serum phospholipids is associated with improved insulin sensitivity in subjects with type 2 diabetes Effect of a Brown Rice Based Vegan Diet and Conventional Diabetic Diet on Glycemic Control of Patients with Type 2 Diabetes: A 12-Week Randomized Clinical Trial Comparative Effectiveness of Dipeptidylpeptidase-4 Inhibitors in Type 2 Diabetes: A Systematic Review and Mixed Treatment Comparison Nonpharmacological interventions to prevent type 2 diabetes in women diagnosed with gestational diabetes mellitus: a systematic overview Obesity, diabetes, hypertension, and vegetarian status among Seventh-Day Adventists in Barbados: preliminary results. A Vegetarian Diet Is a Major Determinant of Gut Microbiota Composition in Early Pregnancy Vegetarian diet, change in dietary patterns, and diabetes risk: a prospective study Behavioural interventions for type 2 diabetes: an evidence-based analysis. Vegetarian dietary patterns and mortality in Adventist Health Study 2. Physical Activity/Exercise and Type 2 Diabetes A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with Type 2 diabetes Glycemic acute changes in type 2 diabetics caused by low and high glycemic index diets. Sources of evidence for systematic reviews of interventions in diabetes. Predominantly Vegetarian Diet in Patients with Incipient and Early Clinical Diabetic Nephropathy: Effects on Albumin Excretion Rate and Nutritional Status Comparative effectiveness of plant-based diets for weight loss: a randomized controlled trial of five different diets. Community-based care for the management of type 2 diabetes: an evidence-based analysis. Mobile App-Based Interventions to Support Diabetes Self-Management: A Systematic Review of Randomized Controlled Trials to Identify Functions Associated with Glycemic Efficacy Addressing Dichotomous Data for Participants Excluded from Trial Analysis: A Guide for Systematic Reviewers Diet, Inflammation, and Glycemic Control in Type 2 Diabetes: An Integrative Review of the Literature Dietary fiber, whole grains, carbohydrate, glycemic index, and glycemic load in relation to risk of prostate cancer Toward improved management of NIDDM: A randomized, controlled, pilot intervention using a lowfat, vegetarian diet.
Background To investigate the prevalence of obesity and diabetes among adult men and women in India consuming different types of vegetarian diets compared with those consuming non-vegetarian diets .  Methods We used cross-sectional data of 156,317 adults aged 20–49 years who participated in India ’s third National Family Health Survey ( 2005–06 ) . Association between types of vegetarian diet ( vegan , lacto-vegetarian , lacto-ovo vegetarian , pesco-vegetarian , semi-vegetarian and non-vegetarian ) and self-reported diabetes status and measured body mass index ( BMI ) were estimated using multivariable logistic regression adjusting for age , gender , education , household wealth , rural/urban residence , religion , caste , smoking , alcohol use , and television watching . Results Mean BMI was lowest in pesco-vegetarians ( 20.3 kg/m2 ) and vegans ( 20.5 kg/m2 ) and highest in lacto-ovo vegetarian ( 21.0 kg/m2 ) and lacto-vegetarian ( 21.2 kg/m2 ) diets . Prevalence of diabetes varied from 0.9 % ( 95 % CI : 0.8 - 1.1 ) in person consuming lacto-vegetarian , lacto-ovo vegetarian ( 95 % CI:0.6 - 1.3 ) and semi-vegetarian ( 95 % CI:0.7 - 1.1 ) diets and was highest in those persons consuming a pesco-vegetarian diet ( 1.4 % ; 95 % CI:1.0 - 2.0 ) . Consumption of a lacto- ( OR:0.67;95 % CI:0.58 - 0.76;p < 0.01 ) , lacto-ovo ( OR:0.70 ; 95 % CI:0.51 - 0.96;p = 0.03 ) and semi-vegetarian ( OR:0.77 ; 95 % CI:0.60 - 0.98 ; p = 0.03 ) diet was associated with a lower likelihood of diabetes than a non-vegetarian diet in the adjusted analyses . Conclusions In this large , nationally representative sample of Indian adults  , lacto- , lacto-ovo and semi-vegetarian diets were associated with a lower likelihood of diabetes . These findings may assist in the development of interventions to address the growing burden of overweight/obesity and diabetes in Indian population . However , prospect i ve studies with better measures of dietary intake and clinical measures of diabetes are needed to clarify this relationship BACKGROUND AND AIMS : Fatty acids are important cellular constituents that may affect many metabolic processes relevant for the development of diabetes and its complications . We showed previously that vegetarian diet leads to greater increase in metabolic clearance rate of glucose ( MCR ) than conventional hypocaloric diet . The aim of this secondary analysis was to explore the role of changes in fatty acid composition of serum phospholipids in diet- and exercise-induced changes in MCR in subjects with type 2 diabetes ( T2D ) . METHODS : Subjects with T2D ( n=74 ) were r and omly assigned into a vegetarian group ( VG , n=37 ) following vegetarian diet or a control group ( CG , n=37 ) following a conventional diet . Both diets were calorie restricted ( −500 kcal day–1 ) . Participants were examined at baseline , 12 weeks of diet intervention and 24 weeks ( subsequent 12 weeks of diet were combined with aerobic exercise ) . The fatty acid composition of serum phospholipids was measured by gas liquid chromatography . MCR was measured by hyperinsulinemic isoglycemic clamp . Visceral fat ( VF ) was measured by magnetic resonance imaging . RESULTS : Linoleic acid ( LA ; 18:2n6 ) increased in VG ( P=0.04 ) , whereas it decreased in CG ( P=0.04 ) in response to dietary interventions . It did not change significantly after the addition of exercise in either group ( group × time P<0.001 ) . In VG , changes in 18:2n6 correlated positively with changes in MCR ( r=+0.22 ; P=0.04 ) and negatively with changes in VF ( r=−0.43 ; P=0.01 ) . After adjustment for changes in body mass index , the association between 18:2n6 and MCR was no longer significant . The addition of exercise result ed in greater changes of phospholipid fatty acids composition in VG than in CG . CONCLUSION : We demonstrated that the insulin-sensitizing effect of a vegetarian diet might be related to the increased proportion of LA in serum phospholipids Objective Several intervention studies have suggested that vegetarian or vegan diets have clinical benefits , particularly in terms of glycemic control , in patients with type 2 diabetes ( T2D ) ; however , no r and omized controlled trial has been conducted in Asians who more commonly depend on plant-based foods , as compared to Western population s. Here , we aim ed to compare the effect of a vegan diet and conventional diabetic diet on glycemic control among Korean individuals . Material s and Methods Participants diagnosed with T2D were r and omly assigned to follow either a vegan diet ( excluding animal-based food including fish ; n = 46 ) or a conventional diet recommended by the Korean Diabetes Association 2011 ( n = 47 ) for 12 weeks . HbA1c levels were measured at weeks 0 , 4 , and 12 , and the primary study endpoint was the change in HbA1c levels over 12 weeks . Results The mean HbA1c levels at weeks 0 , 4 , and 12 were 7.7 % , 7.2 % , and 7.1 % in the vegan group , and 7.4 % , 7.2 % , and 7.2 % in the conventional group , respectively . Although both groups showed significant reductions in HbA1C levels , the reductions were larger in the vegan group than in the conventional group ( -0.5 % vs. -0.2 % ; p-for-interaction = 0.017 ) . When only considering participants with high compliance , the difference in HbA1c level reduction between the groups was found to be larger ( -0.9 % vs. -0.3 % ) . The beneficial effect of vegan diets was noted even after adjusting for changes in total energy intake or waist circumference over the 12 weeks . Conclusion Both diets led to reductions in HbA1c levels ; however , glycemic control was better with the vegan diet than with the conventional diet . Thus , the dietary guidelines for patients with T2D should include a vegan diet for the better management and treatment . However , further studies are needed to evaluate the long-term effects of a vegan diet , and to identify potential explanations of the underlying mechanisms . Trial Registration CRiS Objective To compare the safety and efficacy of the dipeptidylpeptidase-4 ( DPP-4 ) inhibitors in patients with type 2 diabetes and inadequate glycemic control . Design Systematic review of r and omized controlled trials ( RCTs ) , health economic evaluation studies , systematic review s , and meta-analyses , followed by primary Bayesian mixed treatment comparison meta-analyses ( MTCs ) , and secondary frequentist direct-comparison meta-analyses using a r and om-effects model . Outcomes were reported as weighted mean change from baseline , or odds ratio ( OR ) with 95 % credible interval . Data sources MEDLINE , MEDLINE In-Process , EMBASE , and BIOSIS via Dialog ProQuest ; Cochrane Central Register of Controlled Trials and Cochrane Data base of Systematic Review s via EBSCO ; four diabetes and two technical congress abstract s ; and health technology assessment organization websites . Eligibility criteria Patients with type 2 diabetes and inadequate glycemic control receiving any pharmacological anti-diabetic treatment . Data extraction and analysis Title/ abstract s were review ed for eligibility , followed by full-text review of publications remaining after first pass . A three-person team filtered articles and an independent review er checked a r and om selection ( 10 % ) of filtered articles . Data extraction and quality assessment of studies were also independently review ed . Five DPP-4 inhibitors ( alogliptin , linagliptin , saxagliptin , sitagliptin , and vildagliptin ) were compared via meta- analysis ( where data were available ) as monotherapy , dual therapy ( plus metformin , sulfonylurea , pioglitazone , or insulin ) , and triple therapy ( plus metformin/sulfonylurea ) . Results The review identified 6,601 articles ; 163 met inclusion criteria and 85 publications from 83 RCTs contained sufficient or appropriate data for analysis . MTCs demonstrated no differences between DPP-4 inhibitors in mean change from baseline in glycosylated hemoglobin ( HbA1c ) or body weight , or the proportions of patients achieving HbA1c < 7 % or experiencing a hypoglycemic event , apart from in patients on alogliptin plus metformin , who achieved HbA1c < 7 % more frequently than those treated with saxagliptin plus metformin [ OR 6.41 ( 95 % CI 3.15–11.98 ) versus 2.17 ( 95 % CI 1.56–2.95 ) ] . Conclusions This systematic review and MTC showed similar efficacy and safety for DPP-4 inhibitors as treatment for type 2 diabetes , either as monotherapy or combination therapy This systematic overview summarizes the relevant evidence from multiple systematic review s of the benefits of nonpharmacological interventions for preventing  type 2 diabetes mellitus ( T2MD ) in women diagnosed with gestational diabetes mellitus ( GDM ) . A comprehensive search using the Cochrane Library , CINAHL , EMBASE and MEDLINE via Ovid SP , and PubMed data bases was completed on 18 November 2015 . Any systematic review s that evaluated r and omized controlled trials ( RCTs ) with defined nonpharmacological interventions for preventing T2DM in women diagnosed with GDM were eligible for inclusion . The authors independently performed critical appraisal s and quality assessment s of the included review s using the AMSTAR tool , and extracted data were converted to coherent values for tabular summarization . Six eligible review s of diet and /or exercise , breastfeeding , and reminder interventions were identified ; however , the method ologies of the review s varied greatly , and the majority of the evidence suggested unclear bias . We found inconsistent reporting on the rates at which diet and exercise interventions reduced the risk of T2DM progression , but these interventions were found to be effective at reducing glycemic load . Combined diet , exercise , and breastfeeding interventions proved to be effective at returning women to their postpartum weight . Neither diet alone nor exercise alone proved to be effective at lowering the risk of T2DM . Overall , there was no robust evidence to support the hypothesis that nonpharmacological interventions are effective at lowering the risk of T2DM in women diagnosed with GDM , and there was no consistent evidence showing that these interventions improved the predictor outcomes of T2DM , such as glycemic load or anthropometric changes A population -based sample of Seventh-Day Adventists was studied to determine the relationship between vegetarian status , body mass index ( BMI ) , obesity , diabetes mellitus ( DM ) , and hypertension , in order to gain a better underst and ing of factors influencing chronic diseases in Barbados . A systematic sampling from a r and om start technique was used to select participants for the study . A st and ard question naire was used to collect data on demographic and lifestyle characteristics , to record anthropometrics and blood pressure measurements , and to ascertain the hypertension and diabetes status of participants . The sample population consisted of 407 Barbadian Seventh-Day Adventists ( SDAs ) , who ranged in age from 25 to 74 years . One hundred fifty-three ( 37.6 % ) participants were male , and 254 ( 62.4 % ) were female , and 43.5 % were vegetarians . The prevalence rates of diabetes and hypertension were lower among long-term vegetarians , compared to non-vegetarians , and long-term vegetarians were , on average , leaner than non-vegetarians within the same cohort . A significant association was observed between a vegetarian diet and obesity ( vegetarian by definition P=.04 , self-reported vegetarian P=.009 ) in this population . Other components of the study population lifestyle should be further analyzed to determine the roles they may plan in lessening the prevalence rates of obesity , diabetes , and hypertension The composition of the gut microbiota can be influenced by dietary composition . In pregnancy , the maternal gut microbiome has associations with maternal and infant metabolic status . There is little known regarding the impact of a vegetarian diet in pregnancy on maternal gut microbiota . This study explored the gut microbiota profile in women who were vegetarian or omnivorous in early gestation . Women were selected from participants in the Study of PRobiotics IN Gestational diabetes ( SPRING ) r and omised controlled trial . Nine women identified as vegetarians were matched to  omnivorous women in a 1:2 ratio . Microbiota analyses were performed using 16S rRNA gene amplicon sequencing and analysed using the Quantitative Insights Into Microbial Ecology ( QIIME ) and Calypso software tools . There was no difference in alpha diversity , but beta diversity was slightly reduced in vegetarians . There were differences seen in the relative abundance of several genera in those on a vegetarian diet , specifically a reduction in Collinsella , Holdemania , and increases in the relative abundances of Roseburia and Lachnospiraceae . In this sub- analysis of gut microbiota from women in early pregnancy , a vegetarian as compared to omnivorous diet , was associated with a different gut microbiome , with features suggesting alterations in fermentation end products from a mixed acid fermentation towards more acetate/butyrate Background / objectives Vegetarian diets are inversely associated with diabetes in Westerners but their impact on Asians — whose pathophysiology differ from Westerners — is unknown . We aim to investigate the association between a vegetarian diet , change in dietary patterns and diabetes risk in a Taiwanese Buddhist population . Methods We prospect ively followed 2918 non-smoking , non-alcohol drinking Buddhists free of diabetes , cancer , and cardiovascular diseases at baseline , for a median of 5 years , with 183 incident diabetes cases confirmed .  Diet was assessed through a vali date d food frequency question naire at baseline and a simple question naire during follow-ups .  Incident cases of diabetes were ascertained through follow-up question naires , fasting glucose and HbA1C . Stratified Cox Proportional Hazards Regression was used to assess the effect of diets on risk of diabetes . Results Consistent vegetarian diet was associated with 35 % lower hazards ( HR : 0.65 , 95 % CI : 0.46 , 0.92 ) , while converting from a nonvegetarian to a vegetarian pattern was associated with 53 % lower hazards ( HR : 0.47 , 95 % CI : 0.30 , 0.71 ) for diabetes , comparing with nonvegetarians while adjusting for age , gender , education , physical activity , family history of diabetes , follow-up methods , use of lipid-lowering medications , and baseline BMI . Conclusion Vegetarian diet and converting to vegetarian diet may protect against diabetes independent of BMI among Taiwanese UNLABELLED In June 2008 , the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project , an evidence -based review of the literature surrounding strategies for successful management and treatment of diabetes . This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry 's newly released Diabetes Strategy .After an initial review of the strategy and consultation with experts , the secretariat identified five key areas in which evidence was needed . Evidence -based analyses have been prepared for each of these five areas : insulin pumps , behavioural interventions , bariatric surgery , home telemonitoring , and community based care . For each area , an economic analysis was completed where appropriate and is described in a separate report . To review these titles within the Diabetes Strategy Evidence series , please visit the Medical Advisory Secretariat Web site , http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html,DIABETES STRATEGY EVIDENCE PLATFORM : Summary of Evidence -Based AnalysesContinuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics : An Evidence -Based Analysis Behavioural Interventions for Type 2 Diabetes : An Evidence -Based Analysis  BARIATRIC SURGERY FOR PEOPLE WITH DIABETES AND MORBID OBESITY : An Evidence -Based Summary Community-Based Care for the Management of Type 2 Diabetes : An Evidence -Based Analysis Home Telemonitoring for Type 2 Diabetes : An Evidence -Based Analysis Application of the Ontario Diabetes Economic Model ( ODEM ) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario OBJECTIVE The objective of this report is to determine whether behavioural interventions are effective in improving glycemic control in adults with type 2 diabetes . BACKGROUND Diabetes is a serious chronic condition affecting millions of people worldwide and is the sixth leading cause of death in Canada . In 2005 , an estimated 8.8 % of Ontario 's population had diabetes , representing more than 816,000 Ontarians . The direct health care cost of diabetes was $ 1.76 billion in the year 2000 and is projected to rise to a total cost of $ 3.14 billion by 2016 . Much of this cost arises from the serious long-term complications associated with the disease including : coronary heart disease , stroke , adult blindness , limb amputations and kidney disease . Type 2 diabetes accounts for 90 - 95 % of diabetes and while type 2 diabetes is more prevalent in people aged 40 years and older , prevalence in younger population s is increasing due to a rise in obesity and physical inactivity in children . Data from the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) has shown that tight glycemic control can significantly reduce the risk of developing serious complications in type 2 diabetics . Despite physicians ' and patients ' knowledge of the importance of glycemic control , Canadian data has shown that only 38 % of patients with diabetes have HbA1C levels in the optimal range of 7 % or less . This statistic highlights the complexities involved in the management of diabetes , which is characterized by extensive patient involvement in addition to the support provided by physicians . An enormous dem and is , therefore , placed on patients to self-manage the physical , emotional and psychological aspects of living with a chronic illness . Despite differences in individual needs to cope with diabetes , there is general agreement for the necessity of supportive programs for patient self-management . While traditional programs were didactic models with the goal of improving patients ' knowledge of their disease , current models focus on behavioural approaches aim ed at providing patients with the skills and strategies required to promote and change their behaviour . Several meta-analyses and systematic review s have demonstrated improved health outcomes with  self-management support programs in type 2 diabetics . They have all , however , either looked at a specific component of self-management support programs ( i.e. self-management education ) or have been conducted in specific population s. Most review s are also qualitative and do not clearly define the interventions of interest , making findings difficult to interpret . Moreover , heterogeneity in the interventions has led to conflicting evidence on the components of effective programs . There is thus much uncertainty regarding the optimal design and delivery of these programs by policymakers . EVIDENCE -BASED ANALYSIS OF EFFECTIVENESS : RESEARCH QUESTIONS Are behavioural interventions  effective in improving glycemic control in adults with type 2 diabetes?Is the effectiveness of the intervention impacted by intervention characteristics ( e.g. delivery of intervention , length of intervention , mode of instruction , interventionist etc . ) ? INCLUSION CRITERIA English Language Published between January 1996 to August 2008 Type 2 diabetic adult population ( > 18 years)R and omized controlled trials ( RCTs ) Systematic review s , or meta-analyses Describing a multi-faceted self-management support intervention as defined by the 2007 Self-Management Mapping Guide (1)Reporting outcomes of glycemic control ( HbA1c ) with extractable data Studies with a minimum of 6-month follow up EXCLUSION CRITERIA Studies with a control group other than usual care Studies with a sample size < 30 Studies without a clearly defined intervention OUTCOMES OF INTEREST PRIMARY OUTCOME glycemic control ( HbA1c ) SECONDARY OUTCOMES systolic blood pressure ( SBP ) control , lipid control , change in smoking status , weight change , quality of life , knowledge , self-efficacy , managing psychosocial aspects of diabetes , assessing dissatisfaction and readiness to change , and setting and achieving diabetes goals . SEARCH STRATEGY A search was performed in OVID MEDLINE , MEDLINE In-Process and Other Non-Indexed Citations , EMBASE , the Cumulative Index to Nursing & Allied Health Literature ( CINAHL ) , The Cochrane Library , and the International Agency for Health Technology Assessment ( INAHTA ) for studies published between January 1996 and August 2008 . Abstract s were review ed by a single author and studies meeting the inclusion criteria outlined above were obtained . Data on population characteristics , glycemic control outcomes , and study design were extracted . Reference lists were also checked for relevant studies . The quality of the evidence was assessed as being either high , moderate , low , or very low according to the GRADE methodology . SUMMARY OF FINDINGS The search identified 638 citations published between 1996 and August 2008 , of which 12 met the inclusion criteria and one was a meta- analysis ( Gary et al. 2003 ) . The remaining 11 studies were RCTs ( 9 were used in the meta- analysis ) and only one was defined as small ( total sample size N=47 ) . SUMMARY OF PARTICIPANT DEMOGRAPHICS ACROSS STUDIES : A total of 2,549 participants were included in the 11 identified studies . The mean age of participants reported was approximately 58 years and the mean duration of diabetes was approximately 6 years . Most studies reported gender with a mean percentage of females of approximately 67 % . Of the eleven studies , two focused only on women and four included only Hispanic individuals . All studies evaluated type 2 diabetes patients exclusively . STUDY CHARACTERISTICS : The studies were conducted between 2002 and 2008 . Approximately six of 11 studies were carried out within the USA , with the remaining studies conducted in the UK , Sweden , and Israel ( sample size ranged from 47 to 824 participants ) . The quality of the studies ranged from moderate to low with four of the studies being of moderate quality and the remaining seven of low quality ( based on the Consort Checklist ) . Differences in quality were mainly due to method ological issues such as inadequate description of r and omization , sample size calculation allocation concealment , blinding and uncertainty of the use of intention-to-treat ( ITT ) analysis . Patients were recruited from several setting s : six studies from primary or general medical practice s , three studies from the community ( e.g. via advertisements ) , and two from outpatient diabetes clinics . A usual care control group was reported in nine of 11 of the studies and two studies reported some type of minimal diabetes care in addition to usual care for the control group . INTERVENTION CHARACTERISTICS : All of the interventions examined in the studies were mapped to the 2007 Self-management Mapping Guide . The interventions most often focused on problem solving , goal setting and encouraging participants to engage in activities that protect and promote health ( e.g. modifying behaviour , change in diet , and increase physical activity ) . All of the studies examined comprehensive interventions targeted at least two self-care topics ( e.g. diet , physical activity , blood glucose monitoring , foot care , etc . ) . Despite the homogeneity in the aims of the interventions , there was substantial clinical heterogeneity in other intervention characteristics such as duration , intensity , setting , mode of delivery ( group vs. individual ) , interventionist , and outcomes of interest ( discussed below ) . DURATION , INTENSITY AND MODE OF DELIVERY : Intervention duration s ranged from 2 days to 1 year , with many falling into the range of 6 to 10 weeks . The rest of the interventions fell into categories of ≤ 2 weeks ( 2 studies ) , 6 months ( 2 studies ) , or 1 year ( 3 studies ) . Intensity of the interventions varied widely from 6 hours over 2 days , to 52 hours over 1 year ; however , the majority consisted of interventions of 6 to 15 hours . Both individual and group sessions were used to deliver interventions . Group counselling was used in five studies as a mode of instruction , three studies used both individual and group sessions , and one study used individual sessions as its sole mode of instruction . ( ABSTRACT IMPORTANCE Some evidence suggests vegetarian dietary patterns may be associated with reduced mortality , but the relationship is not well established . OBJECTIVE To evaluate the association between vegetarian dietary patterns and mortality . DESIGN Prospect i ve cohort study ; mortality analysis by Cox proportional hazards regression , controlling for important demographic and lifestyle confounders . SETTING Adventist Health Study 2 ( AHS-2 ) , a large North American cohort . PARTICIPANTS A total of 96,469 Seventh-day Adventist men and women recruited between 2002 and 2007 , from which an analytic sample of 73,308 participants remained after exclusions . EXPOSURES Diet was assessed at baseline by a quantitative food frequency question naire and categorized into 5 dietary patterns : nonvegetarian , semi-vegetarian , pesco-vegetarian , lacto-ovo-vegetarian , and vegan . MAIN OUTCOME AND MEASURE The relationship between vegetarian dietary patterns and all-cause and cause-specific mortality ; deaths through 2009 were identified from the National Death Index . RESULTS There were 2570 deaths among 73,308 participants during a mean follow-up time of 5.79 years . The mortality rate was 6.05 ( 95 % CI , 5.82 - 6.29 ) deaths per 1000 person-years . The adjusted hazard ratio ( HR ) for all-cause mortality in all vegetarians combined vs nonvegetarians was 0.88 ( 95 % CI , 0.80 - 0.97 ) . The adjusted HR for all-cause mortality in vegans was 0.85 ( 95 % CI , 0.73 - 1.01 ) ; in lacto-ovo-vegetarians , 0.91 ( 95 % CI , 0.82 - 1.00 ) ; in pesco-vegetarians , 0.81 ( 95 % CI , 0.69 - 0.94 ) ; and in semi-vegetarians , 0.92 ( 95 % CI , 0.75 - 1.13 ) compared with nonvegetarians . Significant associations with vegetarian diets were detected for cardiovascular mortality , noncardiovascular noncancer mortality , renal mortality , and endocrine mortality . Associations in men were larger and more often significant than were those in women . CONCLUSIONS AND RELEVANCE Vegetarian diets are associated with lower all-cause mortality and with some reductions in cause-specific mortality . Results appeared to be more robust in males . These favorable associations should be considered carefully by those offering dietary guidance For decades , exercise has been considered a cornerstone of diabetes management , along with diet and medication . However , high- quality evidence on the importance of exercise and fitness in diabetes was lacking until recent years . The present document summarizes the most clinical ly relevant recent advances related to people with type 2 diabetes and the recommendations that follow from these . Our recently published technical review on physical activity/exercise and type 2 diabetes ( 1 ) includes greater detail on individual studies , on prevention of diabetes , and on the physiology of exercise . The present statement focuses on type 2 diabetes . Issues primarily germane to type 1 diabetes will be covered in a subsequent technical review and ADA Statement . The levels of evidence used are defined by the ADA in ref . 2 . Two r and omized trials each found that lifestyle interventions including ∼150 min/week of physical activity and  diet-induced weight loss of 5–7 % reduced the risk of progression from impaired glucose tolerance ( IGT ) to type 2 diabetes by 58 % ( 3,4 ) . A cluster-r and omized trial found that diet alone , exercise alone , and combined diet and exercise were equally effective in reducting the progression from IGT to diabetes ( 5 ) . Therefore , there is firm and consistent evidence that programs of increased physical activity  and modest weight loss reduce the incidence of type 2 diabetes in individuals with IGT . Boule et al. ( 6 ) undertook a systematic review and meta- analysis on the effects of structured exercise interventions in clinical trials of ≥8 weeks duration on HbA1c ( A1C ) and body mass in people with type 2 diabetes . Postintervention A1C was significantly lower in exercise than control groups ( 7.65 vs. 8.31 % , weighted mean difference −0.66 % ; P < 0.001 ) . In contrast , postintervention body weight did not differ between the exercise and control groups . Meta-regression confirmed that the beneficial effect of exercise on A1C BACKGROUND Low-fat vegetarian and vegan diets are associated with weight loss , increased insulin sensitivity , and improved cardiovascular health . OBJECTIVE We compared the effects of a low-fat vegan diet and conventional diabetes diet recommendations on glycemia , weight , and plasma lipids . DESIGN Free-living individuals with type 2 diabetes were r and omly assigned to a low-fat vegan diet ( n = 49 ) or a diet following 2003 American Diabetes Association guidelines ( conventional , n = 50 ) for 74 wk . Glycated hemoglobin ( Hb A(1c ) ) and plasma lipids were assessed at weeks 0 , 11 , 22 , 35 , 48 , 61 , and 74 . Weight was measured at weeks 0 , 22 , and 74 . RESULTS Weight loss was significant within each diet group but not significantly different between groups ( -4.4 kg in the vegan group and -3.0 kg in the conventional diet group , P = 0.25 ) and related significantly to Hb A(1c ) changes ( r = 0.50 , P = 0.001 ) . Hb A(1c ) changes from baseline to 74 wk or last available values were -0.34 and -0.14 for vegan and conventional diets , respectively ( P = 0.43 ) . Hb A(1c ) changes from baseline to last available value or last value before any medication adjustment were -0.40 and 0.01 for vegan and conventional diets , respectively ( P = 0.03 ) . In analyses before alterations in lipid-lowering medications , total cholesterol decreased by 20.4 and 6.8 mg/dL in the vegan and conventional diet groups , respectively ( P = 0.01 ) ; LDL cholesterol decreased by 13.5 and 3.4 mg/dL in the vegan and conventional groups , respectively ( P = 0.03 ) . CONCLUSIONS Both diets were associated with sustained reductions in weight and plasma lipid concentrations . In an analysis controlling for medication changes , a low-fat vegan diet appeared to improve glycemia and plasma lipids more than did conventional diabetes diet recommendations . Whether the observed differences provide clinical benefit for the macro- or microvascular complications of diabetes remains to be established . This trial was registered at clinical trials.gov as NCT00276939 Aims The aim of this study was to compare the effects of calorie-restricted vegetarian and conventional diabetic diets alone and in combination with exercise on insulin resistance , visceral fat and oxidative stress markers in subjects with Type 2 diabetes . Methods A 24-week , r and omized , open , parallel design was used . Seventy-four patients with Type 2 diabetes were r and omly assigned to either the experimental group ( n = 37 ) , which received a vegetarian diet , or the control group ( n = 37 ) , which received a conventional diabetic diet . Both diets were isocaloric , calorie restricted ( -500 kcal/day ) . All meals during the study were provided . The second 12 weeks of the diet were combined with aerobic exercise . Participants were examined at baseline , 12 weeks and 24 weeks . Primary outcomes were : insulin sensitivity measured by hyperinsulinaemic isoglycaemic clamp ; volume of visceral and subcutaneous fat measured by magnetic resonance imaging ; and oxidative stress measured by thiobarbituric acid reactive substances . Analyses were by intention to treat . Results Forty-three per cent of participants in the experimental group and 5 % of participants in the control group reduced diabetes medication ( P < 0.001 ) . Body weight decreased more in the experimental group than in the control group [ –6.2 kg ( 95 % CI –6.6 to –5.3 ) vs. –3.2 kg ( 95 % CI –3.7 to –2.5 ) ; interaction group × time P = 0.001 ] . An increase in insulin sensitivity was significantly greater in the experimental group than in the control group [ 30 % ( 95 % CI 24.5–39 ) vs. 20 % ( 95 % CI 14–25 ) , P = 0.04 ] . A reduction in both visceral and subcutaneous fat was greater in the experimental group than in the control group ( P = 0.007 and P = 0.02 , respectively ) . Plasma adiponectin increased ( P = 0.02 ) and leptin decreased ( P = 0.02 ) in the experimental group , with no change in the control group . Vitamin C , superoxide dismutase and reduced glutathione increased in the experimental group ( P = 0.002 , P < 0.001 and P = 0.02 , respectively ) . Differences between groups were greater after the addition of exercise training . Changes in insulin sensitivity and enzymatic oxidative stress markers correlated with changes in visceral fat . Conclusions A calorie-restricted vegetarian diet had greater capacity to improve insulin sensitivity compared with a conventional diabetic diet over 24 weeks . The greater loss of visceral fat and improvements in plasma concentrations of adipokines and oxidative stress markers with this diet may be responsible for the reduction of insulin resistance . The addition of exercise training further augmented the improved outcomes with the vegetarian diet INTRODUCTION Low-glycemic index diets may improve the glycemic control in type 2 diabetes but the debate over their effectiveness continues . OBJECTIVES To test the effects of low-glycemic index diets on acute glycemic control ( 2 days ) by measuring capillary blood glucose in patients with type 2 diabetes . METHODS This was a crossover r and omized clinical trial with 12 type 2 diabetics which were r and omly divided into 2 groups and targeted the following draft diets for low and high glycemic index ( LGI and HGI ) for 2 consecutive days in 2 consecutive weeks . Group 1 followed an LGI diet in week 1 and an HGI diet in week 2 , group 2 adopted the contrary . They were oriented to maintain medication and lifestyle and to follow the recommendations . Measurements were made of glycemia capillaries in 2 days ( fasting , before lunch , post-pr and ial lunch and before dinner ) and one last in fasting on day 3 . A food record during the days and the counting of carbohydrates meals was made . The software SigmaStat ( version 2.03 ) was used , with a statistical significance criterion of p < 0.05 . RESULTS AND DISCUSSION The amount of carbohydrates ingested by the LGI group was lower ( p < 0.01 ) , showing that the adoption of this diet reduces the intake of carbohydrates , being favorable for diabetics . Mean blood glucose on the first day was lower in the LGI group ( p < 0.05 ) AIMS To analyse the effect on systematic review s in diabetes interventions of including only trials that are indexed in medline , and to assess the impact of adding trials from other data bases and the grey literature . METHODS All systematic review s of diabetes interventions which included a meta- analysis of r and omized controlled trials , and were published since 1996 , were selected . The impact on the meta- analysis of including only those trials indexed in medline , and the effect of then adding trials from other sources , was assessed . Where possible this was measured quantitatively , by redoing the meta- analysis , otherwise a qualitative estimate was made . RESULTS Forty-four systematic review s met our inclusion criteria . There were 120 articles reporting trial data which were not indexed in medline . These came from 52 % of the review s. In 34 % of the review s , basing a meta- analysis on a search of only medline would miss trials that could affect the result . Sources of non- medline data which had the biggest effect on the meta-analyses were journal articles from central and embase ( mainly in Diabetes , Nutrition and Metabolism ) and unpublished data ( mainly from industry ) . The exceptions were journal articles on herbal medicine , mostly indexed in Chinese language data bases . CONCLUSIONS A search of only the medline data base is insufficient for systematic review s of diabetes , because in about 34 % of review s the missed trials could affect the results of the meta- analysis . It is recommended that central ( on the Cochrane Library ) also be search ed . Scanning meeting abstract s , and seeking unpublished data are also recommended if the intervention has only recently been introduced Several studies have suggested that dietary protein quality may be an important determinant in the natural history of renal disease . We have therefore studied the effects of a predominantly vegetarian diet in eight patients with Type 1 diabetes mellitus and an albumin excretion rate ( AER ) in excess of 30 μg min−1 . The AER was measured after an 8‐week run‐in period on the patient 's usual diet , and again after 8 weeks of a predominantly vegetarian diet in which the proportion of vegetable protein was supplemented in order to minimize the reduction in total dietary protein intake . The median fractional albumin clearance fell during the study from an initial value of 188 times 10−4 ( range 58–810 times 10−4 ) at the end of the run‐in period to 87 times 10−4 ( 23–829 times 10−4 ) at the end of the period on low animal protein diet ( difference 79 times 10−4 ( 95 % Cl 9–149 times 10−4 ) , p < 0.05 ) . The AER then returned to values similar to those obtained at the beginning of the study after a further 8 weeks in those patients returning to their usual diet . No significant changes in blood glucose control or in arterial pressure were observed . A predominantly vegetarian diet may therefore have important beneficial effects on diabetic nephropathy without the need for a heavily restricted total protein intake OBJECTIVE The aim of this study was to determine the effect of plant-based diets on weight loss . METHODS Participants were enrolled in a 6-mo , five-arm , r and omized controlled trial in 2013 in South Carolina . Participants attended weekly group meetings , with the exception of the omnivorous group , which served as the control and attended monthly meetings augmented with weekly e-mail lessons . All groups attended monthly meetings for the last 4 mo of the study . Diets did not emphasize caloric restriction . RESULTS Overweight adults ( body mass index 25 - 49.9 kg/m(2 ) ; age 18 - 65 y , 19 % non-white , and 27 % men ) were r and omized to a low-fat , low-glycemic index diet : vegan ( n = 12 ) , vegetarian ( n = 13 )  , pesco-vegetarian ( n =  13  ) , semi-vegetarian  ( n = 13 ) , or omnivorous  ( n = 12 ) . Fifty ( 79 % ) participants completed the study . In intention-to-treat analysis , the linear trend for weight loss across the five groups was significant at both 2 ( P < 0.01 ) and 6 mo ( P < 0.01 ) . At 6 mo , the weight loss in the vegan group ( -7.5 % ± 4.5 % ) was significantly different from the omnivorous ( -3.1 % ± 3.6 % ; P = 0.03 ) , semi-vegetarian ( -3.2 % ± 3.8 % ; P = 0.03 ) , and pesco-vegetarian ( -3.2 % ± 3.4 % ; P = 0.03 ) groups . Vegan participants decreased their fat and saturated fat more than the pesco-vegetarian , semi-vegetarian , and omnivorous groups at both 2 and 6 mo ( P < 0.05 ) . CONCLUSIONS Vegan diets may result in greater weight loss than more modest recommendations UNLABELLED In June 2008 , the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project , an evidence -based review of the literature surrounding strategies for successful management and treatment of diabetes . This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry 's newly released Diabetes Strategy .After an initial review of the strategy and consultation with experts , the secretariat identified five key areas in which evidence was needed . Evidence -based analyses have been prepared for each of these five areas : insulin pumps , behavioural interventions , bariatric surgery , home telemonitoring , and community based care . For each area , an economic analysis was completed where appropriate and is described in a separate report . To review these titles within the Diabetes Strategy Evidence series , please visit the Medical Advisory Secretariat Web site , http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html,DIABETES STRATEGY EVIDENCE PLATFORM : Summary of Evidence -Based AnalysesContinuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics : An Evidence -Based Analysis Behavioural Interventions for Type 2 Diabetes : An Evidence -Based Analysis BARIATRIC SURGERY FOR PEOPLE WITH DIABETES AND MORBID OBESITY : An Evidence -Based Summary Community-Based Care for the Management of Type 2 Diabetes : An Evidence -Based Analysis Home Telemonitoring for Type 2 Diabetes  : An Evidence -Based Analysis Application of the Ontario Diabetes Economic Model ( ODEM ) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario OBJECTIVE The objective of this report is to determine the efficacy of specialized multidisciplinary community care for the management of type 2 diabetes compared to usual care . CLINICAL NEED TARGET POPULATION AND CONDITION Diabetes ( i.e. diabetes mellitus ) is a highly prevalent chronic metabolic disorder that interferes with the body 's ability to produce or effectively use insulin . The majority ( 90 % ) of diabetes patients have type 2 diabetes . ( 1 ) Based on the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) , intensive blood glucose and blood pressure control significantly reduce the risk of microvascular and macrovascular complications in type 2 diabetics . While many studies have documented that patients often do not meet the glycemic control targets specified by national and international guidelines , factors associated with glycemic control are less well studied , one of which is the provider(s ) of care . Multidisciplinary approaches to care may be particularly important for diabetes management . According guidelines from the Canadian Diabetes Association ( CDA ) , the diabetes health care team should be multi- and interdisciplinary . Presently in Ontario , the core diabetes health care team consists of at least a family physician and /or diabetes specialist , and diabetes educators ( registered nurse and registered dietician ) . Increasing the role played by allied health care professionals in diabetes care and their collaboration with physicians may represent a more cost-effective option for diabetes management . Several systematic review s and meta-analyses have examined multidisciplinary care programs , but these have either been limited to a specific component of multidisciplinary care ( e.g. intensified education programs ) , or were conducted as part of a broader disease management program , of which not all were multidisciplinary in nature . Most review s also do not clearly define the intervention(s ) of interest , making the evaluation of such multidisciplinary community programs challenging . EVIDENCE -BASED ANALYSIS METHODS RESEARCH QUESTIONS What is the evidence of efficacy of specialized multidisciplinary community care provided by at least a registered nurse , registered dietician and physician ( primary care and /or specialist ) for the management of type 2 diabetes compared to usual care ? [ Henceforth referred to as Model 1]What is the evidence of efficacy of specialized multidisciplinary community care provided by at least a pharmacist and a primary care physician for the management of type 2 diabetes compared to usual care ? [ Henceforth referred to as Model 2 ] INCLUSION CRITERIA English language full-reportsPublished between January 1 , 2000 and September 28 , 2008R and omized controlled trials ( RCTs ) , systematic review s and meta-analysesType 2 diabetic adult population ( ≥18 years of age)Total sample size ≥30Describe specialized multidisciplinary community care defined as ambulatory-based care provided by at least two health care disciplines ( of which at least one must be a specialist in diabetes ) with integrated communication between the care providers . Compared to usual care ( defined as health care provision by non-specialist(s ) in diabetes , such as primary care providers ; may include referral to other health care professionals/services as necessary)≥6 months follow-up EXCLUSION CRITERIA Studies where discrete results on diabetes can not be abstract edPredominantly home-based interventions Inpatient-based interventions OUTCOMES OF INTEREST The primary outcomes for this review were glycosylated hemoglobin ( rHbA1c ) levels and systolic blood pressure ( SBP ) . SEARCH STRATEGY A literature search was performed on September 28 , 2008 using OVID MEDLINE , MEDLINE In-Process and Other Non-Indexed Citations , EMBASE , the Cumulative Index to Nursing & Allied Health Literature ( CINAHL ) , the Cochrane Library , and the International Agency for Health Technology Assessment ( INAHTA ) for studies published between January 1 , 2000 and September 28 , 2008 . Abstract s were review ed by a single review er and , for those studies meeting the eligibility criteria , full-text articles were obtained . Reference lists were also examined for any additional relevant studies not identified through the search . Articles with unknown eligibility were review ed with a second clinical epidemiologist , then a group of epidemiologists until consensus was established . The quality of evidence was assessed as high , moderate , low or very low according to GRADE methodology . Given the high clinical heterogeneity of the articles that met the inclusion criteria , specific models of specialized multidisciplinary community care were examined based on models of care that are currently being supported in Ontario , models of care that were commonly reported in the literature , as well as suggestions from an Expert Advisory Panel Meeting held on January 21 , 2009 . SUMMARY OF FINDINGS The initial search yielded 2,116 unique citations , from which 22 RCTs trials and nine systematic review s published were identified as meeting the eligibility criteria . Of these , five studies focused on care provided by at least a nurse , dietician , and physician ( primary care and /or specialist ) model of care ( Model 1 ; see Table ES 1 ) , while three studies focused on care provided by at least a pharmacist and primary care physician ( Model 2 ; see Table ES 2 ) . Based on moderate quality evidence , specialized multidisciplinary community care Model 2 has demonstrated a statistically and clinical ly significant reduction in HbA1c of 1.0 % compared with usual care . The effects of this model on SBP , however , are uncertain compared with usual care , based on very-low quality evidence . Specialized multidisciplinary community care Model 2 has demonstrated a statistically and clinical ly significant reduction in both HbA1c of 1.05 % ( based on high quality evidence ) and SBP of 7.13 mm Hg ( based on moderate quality evidence ) compared to usual care . For both models , the evidence does not suggest a preferred setting of care delivery ( i.e. , primary care vs. hospital outpatient clinic vs. community clinic ) . Table ES1 : Summary of Results of Meta-Analyses of the Effects of Multidisciplinary Care Model 1 Outcome Estimate of effect(95 % CI)Heterogeneity I(2)(p-value ) GRADE Glycosylated Hemoglobin ( HbA1c [%])-1.00 [ -1.27 , -0.73]4 % (p=0.37)Moderate- quality Subgroup : Moderate-to-High Quality -0.91 [ -1.19 , -0.62]0 % (p=0.74)Systolic Blood Pressure ( mm Hg)-2.04 [ -13.80 , 9.72]89 % (p=0.002)Very-low quality * Mean change from baseline to follow-up between intervention and control groupsTable ES2 : Summary of Results of Meta-Analyses of the Effects of Multidisciplinary Care Model 2 Outcome Estimate of effect(95 % CI)Heterogeneity I(2)(p-value ) GRADE Glycosylated Hemoglobin ( HbA1c [%])-1.05 [ -1.57 , -0.52]0 % (p=0.75)High- quality Systolic Blood Pressure ( mm Hg)-7.13 [ -11.78 , -2.48]46 % (p=0.17)Moderate quality * Mean change from baseline to follow-up between intervention and control groups Background Mobile health apps for diabetes self-management have different functions . However , the efficacy and safety of each function are not well studied , and no classification is available for these functions . Objective The aims of this study were to ( 1 ) develop and vali date a taxonomy of apps for diabetes self-management , ( 2 ) investigate the glycemic efficacy of  mobile app-based interventions among adults with diabetes in a systematic review of r and omized controlled trials ( RCTs ) , and ( 3 ) explore the contribution of different function to the effectiveness of entire app-based interventions using the taxonomy . Methods We developed a 3-axis taxonomy with columns of clinical modules , rows of functional modules and cells of functions with risk assessment s. This taxonomy was vali date d by review ing and classifying commercially available diabetes apps . We search ed MEDLINE , EMBASE , the Cochrane Central Register of Controlled Trials , the Chinese Biomedical Literature Data base , and Clinical Trials.gov from January 2007 to May 2016 . We included RCTs of adult out patients with diabetes that compared using  mobile app-based interventions with usual care alone . The mean differences ( MDs ) in hemoglobin A1c ( HbA1c ) concentrations and risk ratios of adverse events were pooled using a r and om-effects meta- analysis . After taxonomic classification , we performed exploratory subgroup analyses of the presence or absence of each module across the included app-based interventions . Results Across 12 included trials involving 974 participants , using app-based interventions was associated with a clinical ly significant reduction of HbA1c ( MD 0.48 % , 95 % CI 0.19%-0.78 % ) without excess adverse events . Larger HbA1c reductions were noted among patients with type 2 diabetes than those with type 1 diabetes ( MD 0.67 % , 95 % CI 0.30%-1.03 % vs MD 0.37 % , 95 % CI –0.12%-0.86 % ) . Having a complication prevention module in app-based interventions was associated with a greater HbA1c reduction ( with complication prevention : MD 1.31 % , 95 % CI 0.66%-1.96 % vs without : MD 0.38 % , 95 % CI 0.09%-0.67 % ; intersubgroup P=.01 ) , as was having a structured display ( with structured display : MD 0.69 % , 95 % CI 0.32%-1.06 % vs without : MD 0.69 % , 95 % CI –0.18%-0.53 % ; intersubgroup P=.03 ) . However , having a clinical decision-making function was not associated with a larger HbA1c reduction ( with clinical decision making : MD 0.19 % , 95 % CI –0.24%-0.63 % vs without : MD 0.61 % , 95 % CI 0.27%-0.95 % ; intersubgroup P=.14 ) . Conclusions The use of mobile app-based interventions yields a clinical ly significant HbA1c reduction among adult out patients with diabetes , especially among those with type 2 diabetes . Our study suggests that the clinical decision-making function needs further improvement and evaluation before being added to apps Introduction Systematic review er authors intending to include all r and omized participants in their meta-analyses need to make assumptions about the outcomes of participants with missing data . Objective The objective of this paper is to provide systematic review er authors with a relatively simple guidance for addressing dichotomous data for participants excluded from analyses of r and omized trials . Methods This guide is based on a review of the Cochrane h and book and published method ological research . The guide deals with participants excluded from the analysis who were considered ‘ non-adherent to the protocol ’ but for whom data are available , and participants with missing data . Results Systematic review er authors should include data from ‘ non-adherent ’ participants excluded from the primary study authors ' analysis but for whom data are available . For missing , unavailable participant data , authors may conduct a complete case analysis ( excluding those with missing data ) as the primary analysis . Alternatively , they may conduct a primary analysis that makes plausible assumptions about the outcomes of participants with missing data . When the primary analysis suggests important benefit , sensitivity meta-analyses using relatively extreme assumptions that may vary in plausibility can inform the extent to which risk of bias impacts the confidence in the results of the primary analysis . The more plausible assumptions draw on the outcome event rates within the trial or in all trials included in the meta- analysis . The proposed guide does not take into account the uncertainty associated with assumed events . Conclusions This guide proposes methods for h and ling participants excluded from analyses of r and omized trials . These methods can help in establishing the extent to which risk of bias impacts meta- analysis results Type 2 diabetes ( T2D ) is a growing national health problem affecting 35 % of adults ≥20 years of age in the United States . Recently , diabetes has been categorized as an inflammatory disease , sharing many of the adverse outcomes as those reported from cardiovascular disease . Medical nutrition therapy is recommended for the treatment of diabetes ; however , these recommendations have not been up date d to target the inflammatory component , which can be affected by diet and lifestyle . To assess the current state of evidence for which dietary programs contain the most anti-inflammatory and glycemic control properties for patients with T2D , we conducted an integrative review of the literature . A comprehensive search of the PubMed , CINAHL , Scopus , and Web of Science data bases from January 2000 to May 2012 yielded 786 articles . The final 16 studies met the selection criteria including r and omized control trials , quasiexperimental , or cross-sectional studies that compared varying diets and measured inflammatory markers . The Mediterranean and DASH diets along with several low-fat diets were associated with lower inflammatory markers . The Mediterranean diet demonstrated the most clinical ly significant reduction in glycosylated hemoglobin ( HbA1c ) . Information on best dietary guidelines for inflammation and glycemic control in individuals with T2D is lacking . Continued research is warranted Background The relationships between dietary fiber , whole grains , carbohydrate , glycemic index ( GI ) , glycemic load ( GL ) , and prostate cancer risk are unclear . We conducted a systematic review and meta- analysis to investigate these associations . Methods Relevant studies were identified by a search of PubMed data base and EMBASE data base up to April 2015 . A r and om effects model was used to calculate the summary relative risks ( RRs ) and their corresponding 95 % confidence intervals ( CIs ) . Results Twenty-seven epidemiological studies ( 18 case – control studies and nine cohort studies ) were included in the final analysis .  The pooled RRs of prostate cancer were 0.94 ( 95 % CI 0.85–1.05 , P=0.285 ) , 1.13 ( 95 % CI 0.98–1.30 , P=0.095 ) , 0.96 ( 95 % CI 0.81–1.14 , P=0.672 ) , 1.06 ( 95 % CI 0.96–1.18 , P=0.254 ) , and 1.04 ( 95 % CI 0.91–1.18 , P=0.590 ) for dietary fiber , whole grains , carbohydrate , GI , and GL , respectively . There was no evidence of significant publication bias based on the Begg ’s test and Egger ’s test . Conclusion The findings of this meta- analysis indicate that , based on available information , dietary fiber , whole grains , carbohydrate , GI , and GL are not associated with the risk of prostate cancer OBJECTIVE To investigate whether glycemic and lipid control in patients with non-insulin-dependent diabetes ( NIDDM ) can be significantly improved using a low-fat , vegetarian ( vegan ) diet in the absence of recommendations regarding exercise or other lifestyle changes . METHODS Eleven subjects with NIDDM recruited from the Georgetown University Medical Center or the local community were r and omly assigned to a low-fat vegan diet ( seven subjects ) or a conventional low-fat diet ( four subjects ) . Two additional subjects assigned to the control group failed to complete the study . The diets were not design ed to be isocaloric . Fasting serum glucose , body weight , medication use , and blood pressure were assessed at baseline and biweekly thereafter for 12 weeks . Serum lipids , glycosylated hemoglobin , urinary albumin , and dietary macronutrients were assessed at baseline and 12 weeks . RESULTS Although the sample was intentionally small in accordance with the pilot study design , the 28 % mean reduction in fasting serum glucose of the experimental group , from 10.7 to 7.75 mmol/L ( 195 to 141 mg/dl ) , was significantly greater than the 12 % decrease , from 9.86 to 8.64 mmol/L ( 179 to 157 mg/dl ) , for the control group ( P < 0.05 ) . The mean weight loss was 7.2 kg in the experimental group , compared to 3 . 8 kg for the control group ( P < 0.005 ) . Of six experimental group subjects on oral hypoglycemic agents , medication use was discontinued in one and reduced in three . Insulin was reduced in both experimental group patients on insulin . No patient in the control group reduced medication use . Differences between the diet groups in the reductions of serum cholesterol and 24-h microalbuminuria did not reach statistical significance ; however , high-density lipoprotein concentration fell more sharply ( 0.20 mmol/L ) in the experimental group than in the control group ( 0.02 mmol/L ) ( P < 0.05 ) . CONCLUSION The use of a low-fat , vegetarian diet in patients with NIDDM was associated with significant reductions in fasting serum glucose concentration and body weight in the absence of recommendations for exercise . A larger study is needed for confirmation
Consumption of vegetarian diets is associated with improved glycemic control in type 2 diabetes .
INTRODUCTION Previous studies have suggested an association between vegetarian diets and improvements in glycemic control in diabetes , although this relationship is not well established .
No meta- analysis of these studies has been performed .
METHODS To conduct a systematic review and meta- analysis of controlled clinical trials examining the association between  vegetarian diets  and  glycemic control in type 2 diabetes .