Journal of Diabetes Research

Review Article

Efficacy of Intermittent or Continuous Very Low-Energy Diets in Overweight and Obese Individuals with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analyses

Table 3

The GRADE evidence of VLEDs compared to LEDs for overweight and obese people with type 2 diabetes mellitus.
Quality assessmentNo. of patientsEffectQualityImportance
No. of studiesDesignRisk of biasInconsistencyIndirectnessImprecisionOther considerationsVLEDLEDRelative (95% CI)Absolute
Weight (better indicated by lower values)
 8Randomized trialsSerious1No serious inconsistencySerious2No serious imprecisionNone246241—MD -1.86 lower (-3.34 to -0.37 lower)Low9
Weight: end of the intervention (better indicated by lower values)
 5Randomized trialsSerious1No serious inconsistencySerious2No serious imprecisionNone151146—MD -2.77 lower (-4.81 to -0.72 lower)Low9
Weight: (better indicated by lower values)
 3Randomized trialsSerious1No serious inconsistencySerious2Serious3None9595—MD -0.84 lower (-3.01 lower to 1.32 higher)Very low9
Glucose (better indicated by lower values)
 6Randomized trialsSerious1No serious inconsistencySerious2No serious imprecisionNone187180—MD -1.26 lower (-1.97 to -0.55 lower)Low8
Glucose: end of the intervention (better indicated by lower values)
 3Randomized trialsSerious1No serious inconsistencySerious2No serious imprecisionNone7576—MD -1.18 lower (-2.05 to -0.3 lower)Low8
Glucose: (better indicated by lower values)
 3Randomized trialsSerious1No serious inconsistencySerious2Serious4None112104—MD -1.43 lower (-2.65 to -0.2 lower)Very low8
TG (better indicated by lower values)
 6Randomized trialsSerious1No serious inconsistencySerious2No serious imprecisionNone185179—MD 0.31 lower (-0.5 to -0.13 lower)Low7
TG: end of the intervention (better indicated by lower values)
 3Randomized trialsSerious1No serious inconsistencySerious2No serious imprecisionNone7576—MD -0.35 lower (-0.58 to -0.12 lower)Low7
TG: (better indicated by lower values)
 3Randomized trialsSerious1No serious inconsistencySerious2Serious4None110103—MD -0.25 lower (-0.55 lower to 0.06 higher)Very low7
Dropout
 6Randomized trialsSerious1No serious inconsistencySerious2No serious imprecisionNone57/253
(22.5%)		69/253
(27.3%)		OR 0.74 (0.49 to 1.13)56 fewer per 1000 (from 118 fewer to 25 more)Low6
 21.4%46 fewer per 1000 (from 96 fewer to 21 more)
CI: confidence interval; OR: odds ratio. GRADE Working Group grades of evidence: high quality: further research is very unlikely to change our confidence in the estimate of effect; moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate; low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate; very low quality: we are very uncertain about the estimate. 1There are studies that do not account for specific stochastic methods, so they are reduced by one level. 2Interventions include continuous VLEDs and intermittent VLEDs, which differ to some extent, so they are reduced by one level. 3No explanation was provided. 4The ratio of 95% CI to the effect is more than 50%. 95% CI is wider and its accuracy is poor, so it decreases one level.