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
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
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 .