588-P: Nutrient Intake Order on Metabolic Outcomes in Type 2 Diabetes—A Systematic Review and Meta-analysis

Introduction and Objective: Non-pharmacological therapies for type 2 diabetes (T2D) require simpler, adaptable recommendations that align with diverse contexts, preferences, and long-term goals. This study aims to evaluate the impact of a carbohydrate-last (CL) strategy compared to carbohydrate-first or unordered (CF) nutrient intake on metabolic parameters in T2D. Methods: PubMed, EMBASE, and Cochrane Central were systematically searched for randomized controlled trials (RCTs) evaluating nutrient intake order in T2D. Mean difference (MD) with 95% confidence intervals (CI) was used for all outcomes. Heterogeneity was assessed with I² statistics. Statistical analyses were performed using R version 4.2.3. Results: Seventeen studies involving 389 participants were included, with 114 (29%) in a parallel design and 192 (49%) in a crossover design receiving CL. In the pooled analysis, the CL group had significantly lower postprandial glucose at 120 minutes (MD: -13.00 mg/dL; 95% CI: -21.07, -4.93; p<0.01). Insulin levels at 120 minutes postprandial (MD: -3.90 uIU/mL; 95% CI: -16.85, 9.04; p=0.55) showed no significant differences. The CL group had significantly higher postprandial GLP-1 levels at 120 minutes (MD: 8.21 pmol/L; 95% CI: 2.33, 14.09; p<0.01), while GIP levels at the same time point (MD: 5.79 pmol/L; 95% CI: -6.33, 17.90; p=0.35) showed no significant differences. Gastric emptying half-time in the CL group (MD: 28.14 min; 95% CI: 16.06, 40.23; p<0.01) was significantly delayed. Glycated hemoglobin (HbA1C) levels at the end of the follow-up (MD: -0.16%; 95% CI: -0.31, -0.01; p=0.04) were significantly lower in the CL group. Conclusion: Carbohydrate-last nutrient intake is associated with improved postprandial glucose profile and HbA1C levels in individuals with T2D. Further research is needed to confirm its sustainability and applicability across diverse populations. Disclosure L. Saldarriaga: None. A.D. Andrade: None. P. Ratan: None. S. Kodalak: None. E. Pasqualotto: None. T.G. Bovi: None. T. Trevisan: None.