{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T03:00:28Z","timestamp":1790823628210,"version":"4.1.0"},"reference-count":72,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The relative benefits of carbohydrate\u2010restricted diets (CRDs) combined with exercise in adults with type 2 diabetes remain uncertain. We compared regimens and explored incremental benefits, dose\u2013response associations and potential effect modifiers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Four databases were searched from inception to 31 August 2026 for English\u2010language randomized controlled trials (RCTs). A Bayesian multilevel model synthesized arm\u2010level changes in glycated haemoglobin (HbA1c) across eligible post\u2010baseline assessments. An auxiliary frequentist network meta\u2010analysis evaluated network structure and inconsistency; Confidence in Network Meta\u2010Analysis (CINeMA) assessed 20 prespecified comparisons. Dose\u2013response and moderator analyses were exploratory. Risk of bias was assessed using the revised Cochrane tool for randomized trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010four RCTs involving 2038 participants were included. Compared with pooled active\/passive controls, aerobic training plus a moderately low\u2010carbohydrate diet was associated with lower HbA1c (posterior median mean difference, \u22120.53 percentage points; 95% credible interval, \u22120.76 to \u22120.28). Estimates for other combined regimens were less precise. The auxiliary network had two disconnected components, and confidence was very low for all 20 assessed comparisons. Under the specified priors, the Bayes factor favoured the model without treatment\u2010specific effects (BF10\u2009=\u20090.034). Higher prescribed exercise doses were associated with larger reductions versus pooled controls, but an incremental benefit over exercise or CRD alone was not established. Matched carbohydrate\u2010dose contrasts were imprecise.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Limitations of the arm\u2010level model, sparse evidence and very low confidence in the assessed auxiliary\u2010network comparisons leave comparative benefits uncertain. The findings do not establish a preferred regimen, an incremental benefit over either component alone, or a specific dietary or exercise prescription.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.71406","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T02:43:01Z","timestamp":1790822581000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of a Low\u2010Carbohydrate Diet Combined With Exercise on\n                    <scp>HbA1c<\/scp>\n                    in Adults With Type 2 Diabetes: A Bayesian Multilevel Network and Dose\u2013Response Meta\u2010Analysis"],"prefix":"10.1111","author":[{"given":"Xiaotong","family":"Wang","sequence":"first","affiliation":[{"name":"School of Physical Education Shanxi Normal University  Taiyuan Shanxi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1430-0977","authenticated-orcid":false,"given":"Mingyue","family":"Jiao","sequence":"additional","affiliation":[{"name":"School of Teacher Education Hezhou University  Hezhou Guangxi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenzheng","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Physical Education Shandong Management University  Jinan Shandong China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dci22\u20100034"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc26\u2010S005"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc26\u2010S006"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(98)07019\u20106"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m4743"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD013334.pub2"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc16\u20101728"},{"issue":"17","key":"e_1_2_14_9_1","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1001\/jama.2011.576","article-title":"Physical Activity Advice Only or Structured Exercise Training and Association With HbA1c Levels in Type 2 Diabetes: A Systematic Review and Meta\u2010Analysis","volume":"305","author":"Umpierre D.","year":"2011","journal-title":"Journal of the American Medical Association"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40279\u2010022\u201001673\u20104"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2025.112027"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.70379"},{"issue":"5","key":"e_1_2_14_13_1","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1177\/0272989X12458724","article-title":"Evidence Synthesis for Decision Making 2: A Generalized Linear Modeling Framework for Pairwise and Network Meta\u2010Analysis of Randomized Controlled Trials","volume":"33","author":"Dias S.","year":"2013","journal-title":"Medical Decision Making"},{"issue":"5","key":"e_1_2_14_14_1","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1177\/0962280220982643","article-title":"A Bayesian Dose\u2013Response Meta\u2010Analysis Model: A Simulations Study and Application","volume":"30","author":"Hamza T.","year":"2021","journal-title":"Statistical Methods in Medical Research"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"issue":"11","key":"e_1_2_14_16_1","doi-asserted-by":"crossref","first-page":"777","DOI":"10.7326\/M14-2385","article-title":"The PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta\u2010Analyses of Health Care Interventions: Checklist and Explanations","volume":"162","author":"Hutton B.","year":"2015","journal-title":"Annals of Internal Medicine"},{"key":"e_1_2_14_17_1","doi-asserted-by":"crossref","DOI":"10.1002\/9781119536604","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins J. 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