A systematic review and meta-analysis to assess the effect of hidden hunger on glycaemic control in patients with type 2 diabetes

Abstract

Type 2 diabetes (T2D) is the most common type of diabetes worldwide, accounting for over 90% of all cases. Micronutrient deficiencies (hidden hunger) are implicated in glycaemic control among T2D patients. This systematic review and meta-analysis aim to investigate the association between multiple micronutrient deficiencies and glycaemic control in patients with type 2 diabetes (T2D). The systematic review and meta-analysis followed the Cochrane Handbook and PRISMA 2020 standards. We searched various databases to identify relevant studies and used a pre-piloted data extraction sheet to gather information. Statistical analysis was conducted using R version 4.3.2 and specific packages. A weak but significant negative correlation was observed between overall micronutrient deficiencies and glycaemic control indices: Fasting Blood Glucose (FBG), Post Prandial Blood Glucose (PPBG), and Glycosylated haemoglobin (HbA1c). Vitamin D deficiency had a small but significant correlation with FBG [-0.0920, p-value = 0.0285], PPBG [-0.2416, p-value = 0.0175), and HbA1c, ([-0.1975, p-value < 0.01]. However, there was no significant correlation with HOMA IR. Magnesium deficiency was moderately correlated with HbA1c[-0.3526, p-value < 0.01]and HOMA IR [-0.3427, p-value = 0.0016). Zinc had a negligible correlation with Hb1Ac, while iron and vitamin B12 had a low positive correlation. Study reported as statistically significant but weak negative correlation amongst micronutrient deficiency and glycaemic control among T2D patients. Only a small percentage of the variation in HbA1c, FBG, PPBG, and HOMA IR was attributable to micronutrient deficiencies. This study presents the limited explanatory power of micronutrient deficiencies alone on glycaemic control. Systematic Review Registration: PROSPERO registration number- CRD42023439780. “https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=439780”.