Frontiers in Nutrition · Jul 15, 2026

Comparative efficacy of dietary interventions for overweight or obese adults with type 2 diabetes: a systematic review and network meta-analysis of randomized controlled trials

By Xu R, Chang Y, Su E et al.

BACKGROUND: Dietary intervention is a cornerstone of management for patients with type 2 diabetes who are overweight or obese; however, the optimal strategy remains uncertain. We therefore conducted a network meta-analysis to compare the effects of time-restricted eating (TRE), short-term fasting (STF), and continuous energy restriction (CER) vs. general diet (GD) on glycemic, anthropometric, and lipid-related outcomes. METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched for randomized controlled trials published through 15 February 2026. Eligible studies enrolled overweight or obese adults with type 2 diabetes undergoing TRE, STF, or CER, with GD as the comparator. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. A frequentist random-effects network meta-analysis was conducted using Stata 17.0 (MP), with interventions ranked by the surface under the cumulative ranking curve (SUCRA). Univariable network meta-regression was used to explore potential effect modifiers. Pairwise random-effects meta-analyses were performed as supportive analyses for available direct comparisons. Evidence certainty was evaluated using the CINeMA framework. RESULTS: We included 13 RCTs involving 805 participants. In the network meta-analysis, TRE was associated with a significant reduction in body weight (MD = -2.32 kg, 95% CI: -2.99 to -1.65), BMI (MD = -1.32 kg/m², 95% CI: -1.71 to -0.92), waist circumference (MD = -3.69 cm, 95% CI: -5.07 to -2.30), and fasting blood glucose (MD = -0.85 mmol/L, 95% CI: -1.24 to -0.47). Compared with GD, TRE significantly reduced HbA1c (MD = -0.55, 95% CI: -0.77 to -0.33) and total cholesterol (MD = -0.17 mmol/L, 95% CI: -0.19 to -0.14). CER showed similar favorable effects on HbA1c, body weight, BMI, and waist circumference. According to SUCRA and treatment probability rankings, TRE consistently ranked first for multiple outcomes. The evidence for STF remained insufficient to draw definitive conclusions. CONCLUSION: TRE was associated with favorable effects on glycemic control, weight reduction, and waist circumference, and it ranked highly across multiple outcomes. However, direct comparisons between TRE and CER were generally not statistically significant. Therefore, TRE may be considered a promising dietary strategy, while CER also remains an effective option for selected metabolic outcomes. In practice, dietary strategies should be individualized according to the patient's clinical profile and treatment needs. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, identifier (CRD420261339818).

doi.org/10.3389/fnut.2026.1853598Open accessPubMed 42528610Interventions