Researchers compared two ways to help people with type 2 diabetes lose weight and control their blood sugar: special meal plans combined with lifestyle changes, or prescription medications. After reviewing 101 studies involving nearly 88,000 patients, they found that the meal plan approach worked better for weight loss, helping people lose 2-3 times more weight than medications. Both methods worked equally well for controlling blood sugar over the long term. This suggests that for overweight people with type 2 diabetes, trying a structured meal plan first might be just as effective as taking medications, with the added benefit of losing more weight.

The Quick Take

  • What they studied: Whether a special meal plan combined with lifestyle changes works better than diabetes medications for helping people lose weight and control their blood sugar
  • Who participated: Nearly 88,000 people with type 2 diabetes who were overweight, averaging 60 years old, from 101 different research studies conducted worldwide
  • Key finding: People using the meal plan approach lost about 5-7 kg (11-15 pounds) compared to 2-3 kg (4-7 pounds) with medications, but both methods lowered blood sugar levels equally well over time
  • What it means for you: If you have type 2 diabetes and are overweight, a structured meal plan might help you lose more weight than medications alone, while keeping your blood sugar under control just as well. However, talk with your doctor about what’s best for your situation, as some people may benefit from combining both approaches.

The Research Details

This was a systematic review, which means researchers looked at and compared results from 101 different published studies. They searched for studies that tested either special meal plans (called formula diets) combined with lifestyle changes, or prescription medications for diabetes. The meal plan studies involved 3 large programs, while the medication studies included 47 different randomized controlled trials—the gold standard type of research where some people get the treatment and others get a placebo (fake pill). The researchers carefully selected studies that measured the same things: how much weight people lost and how well their blood sugar was controlled, measured by a test called HbA1c.

The researchers used a special method to compare results fairly across all these different studies. They looked at both short-term results (less than 12 months) and long-term results (12 months or longer) to see if one approach worked better over time. This approach helps researchers combine information from many studies to see the bigger picture.

This type of research is important because it brings together evidence from many different studies to give us a clearer answer than any single study could provide. Since nearly 88,000 people were included across these studies, we can be more confident in the results. The researchers also compared similar types of medications (newer drugs like GLP-1 medications and SGLT-2 inhibitors) to make sure the comparison was fair.

This systematic review included only randomized controlled trials for the medication studies, which is the highest quality type of research. The large sample size of nearly 88,000 people makes the findings more reliable. However, the meal plan studies were fewer in number (only 3 large programs) compared to medication studies (47 studies), which means there’s less research data on the lifestyle approach. The researchers were transparent about their methods, making it easier to trust their conclusions.

What the Results Show

The meal plan approach led to significantly greater weight loss than medications. In studies lasting less than 12 months, people on meal plans lost an average of 5.6 kg (about 12 pounds) compared to 2.6 kg (about 6 pounds) with medications. In longer studies lasting 12 months or more, the difference was even bigger: 7.3 kg (about 16 pounds) with meal plans versus 3.1 kg (about 7 pounds) with medications.

For blood sugar control, measured by a test called HbA1c, the results were different. In the short term, medications appeared slightly better at lowering blood sugar (-0.9% vs -0.6%). However, over the long term (12 months or longer), both approaches worked equally well, with both reducing HbA1c by about 0.7%.

This means that while meal plans help people lose much more weight, medications and meal plans are about equally effective at controlling blood sugar over time. The weight loss advantage of meal plans is important because losing weight itself helps improve diabetes control and overall health.

The research showed that the newer medications tested (GLP-1 receptor agonists, GIP/GLP-1 combinations, and SGLT-2 inhibitors) were the most effective medications studied. These are newer drugs that work differently than older diabetes medications. The comparison focused on these newer medications because they’ve shown the best results in recent research. The findings suggest that even when compared to the most effective medications available, lifestyle and meal plan interventions still produce better weight loss results.

This research supports what many previous studies have suggested: lifestyle changes and weight loss are powerful tools for managing type 2 diabetes. The finding that meal plans work as well as medications for blood sugar control aligns with earlier research showing that significant weight loss can sometimes even reverse type 2 diabetes. However, this is one of the first systematic reviews to directly compare modern medications with structured meal plan programs, making it a valuable update to what we know.

The main limitation is that there were far fewer studies on meal plan programs (only 3 large programs) compared to medication studies (47 studies). This means we have less research data on how well meal plans work overall. Additionally, the meal plan studies may have had different designs and patient populations than the medication studies, making direct comparison challenging. The studies also varied in how long they lasted and how carefully they tracked whether people stuck with their programs. Finally, this review looked at average results—individual people may respond very differently to either approach.

The Bottom Line

For overweight people newly diagnosed with type 2 diabetes, trying a structured meal plan combined with lifestyle changes is a reasonable first step, as it may produce better weight loss results than medications alone (moderate confidence). If a meal plan approach alone doesn’t work well enough after a few months, adding medications is still a good option since they work equally well for blood sugar control (high confidence). Some people may benefit from combining both approaches from the start, especially if their blood sugar is very high or if they have difficulty following a meal plan (moderate confidence). Always work with your doctor to decide what’s best for your individual situation.

This research is most relevant for people who are overweight and have recently been diagnosed with type 2 diabetes, or those who haven’t yet started medications. It’s also important for people who prefer to try lifestyle changes before taking medications. Healthcare providers should consider this information when deciding whether to recommend meal plans or medications first. However, people with very high blood sugar levels, those who have had diabetes for many years, or those with complications may need medications regardless of this research. Pregnant women and people with type 1 diabetes should not apply these findings.

Weight loss from a meal plan typically becomes noticeable within 4-8 weeks, with the most significant results appearing after 3-6 months. Blood sugar improvements can happen even faster, sometimes within 2-4 weeks of starting a meal plan. However, the full benefits take time—the studies in this review lasted at least several months to see the complete picture. If you’re trying a meal plan approach, give it at least 3 months before deciding whether it’s working well enough for you.

Want to Apply This Research?

  • Track your weight weekly (same day, same time) and record your meal plan adherence daily by logging meals. Also track your HbA1c test results every 3 months when you get them from your doctor—this shows your average blood sugar over time.
  • Use the app to follow a structured meal plan by logging all meals and snacks, aiming for consistency rather than perfection. Set a goal to follow the meal plan 5-6 days per week, and use the app’s reminders to help you stay on track. Include daily activity tracking (walking, exercise) as part of your lifestyle changes.
  • Check in weekly with your weight and meal adherence data. Every month, review your overall progress and adjust your meal plan if needed. Every 3 months, compare your HbA1c results from your doctor visits to see if your blood sugar control is improving. Use the app to share this data with your healthcare provider to guide treatment decisions.

This research summary is for educational purposes only and should not replace professional medical advice. The findings suggest that meal plans may be effective for weight loss in type 2 diabetes, but individual results vary greatly. Before making any changes to your diabetes treatment—whether starting a meal plan, stopping medications, or changing your approach—consult with your doctor or diabetes educator. Some people need medications for safety reasons, and stopping or delaying medications without medical guidance can be dangerous. This review looked at average results from many studies; your personal situation may be different. If you have type 1 diabetes, are pregnant, or have diabetes complications, these findings may not apply to you.