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Different SRs (81-84) have assessed the effectiveness of non-pharmacological
(81; 82; 84) and pharmacological (83) interventions on the loss of weight in
type 2 diabetic patients. The reviews cannot assess morbimortality due to the short
duration of the RCTs included.
The cohort studies associate intentional loss weight in obese diabetic patients
with a fall in the mortality rate in the long-term (85).
The first SR (84) is based on 22 studies, with an at least 12-month followup,
which assesses dietary interventions (diets low in calories or diets very low in
calories), encouraging physical exercise and behavioural therapies. Overall, the
measures achieve a slight reduction of weight: 1.7 kg (CI 95%: 0.3 to 3.2). In the
RCTs where several simultaneous strategies were used, for example, a combination
of diet, exercise and behavioural therapies, the loss of weight was higher:
4.1 kg (CI 95%: 2.9 to 5.4).The weight difference observed between diets on low
calories and very low calories was not statistically significant.
The second review (82) assessed the effects of the different types of guidance.
There is coherence in that the association of diet and exercise conveys more
weight loss. Another aspect stated in this review is the effect of the modification in
the proportion of immediate principles of the diet. The five RCTs which compared
the effect of the low fat diets in contrast to others with moderate fat or reductions
in the amount of carbohydrates showed a higher reduction in weight with the low
fat diet.
The third SR (81) states that hypocaloric diets with around 55% to 60% of
carbohydrates together with a high amount of fibre (>20 g/day), increase moderate
loss weight and improve glycemic control as well as the lipid profile. There is no
study performed with low carbohydrate diets (