Mongkolsucharitkul P.Surawit A.Pimsen A.Winitchayothin S.Pumeiam S.Pinsawas B.Ophakas S.Suta S.Pasookhush P.Mayurasakorn K.Mahidol University2025-09-212025-09-212025-11-01Diabetes Research and Clinical Practice Vol.229 (2025)01688227https://repository.li.mahidol.ac.th/handle/123456789/112091Aims: Low-carbohydrate diets (LCDs) have emerged as a potential dietary intervention for managing glycemic control, but their effectiveness across different cultural contexts remains unclear. To evaluate the efficacy of LCDs in managing type 2 diabetes, with attention to cultural context, and to clarify how variability in carbohydrate definitions affects interpretation. Methods: We searched PubMed, Embase, and Scopus from inception to 1 August 2024 for randomized controlled trials (RCTs) ≥ 12 weeks in adults with type 2 diabetes. We conducted exploratory analyses by Eastern versus Western setting and dose–response meta-regression using actual carbohydrate intake at the follow-up. Results: Twenty-seven RCTs (n = 2,870; 7 Eastern, 20 Western) were included. Across analyzed time points, no arm sustained carbohydrate intake < 10 % of total energy; therefore, findings generalize to low-to-moderate carbohydrate rather than very-low-carbohydrate. LCDs improved glycemia short-term: HbA1c − 0.29 %, with the largest effect at 3 months. Fasting blood glucose decreased overall (−7.12 mg/dL). Weight loss was greatest at 3 months and attenuated thereafter. At 3 months, lower actual carbohydrate intake was related to larger HbA1c and weight reductions. Conclusions: LCDs offer modest, short-term metabolic benefits for type 2 diabetes management, but benefits diminish over time. Cultural context may shape responses, underscoring individualized, culturally tailored care.Biochemistry, Genetics and Molecular BiologyMedicineReviewSCOPUS10.1016/j.diabres.2025.1124642-s2.0-10501539611718728227