The Impact of Macronutrient Ordering on Postprandial Glycaemic Control in Diabetes: A Systematic Review

AIMS: This systematic review aims to investigate if macronutrient ordering is effective at lowering postprandial glucose excursions in individuals with diabetes. METHODS: A systematic search of Medline, Embase and Web of Science was conducted up to February 2025. Two independent reviewers screened title and abstract using Covidence software. Data extraction and risk of bias assessment were performed by one reviewer and checked by a second reviewer. Findings were synthesized narratively. PROSPERO registration: CRD42025639742. RESULTS: In total, we included six studies involving 144 participants. Most studies reported that a carbohydrate last meal pattern was effective at lowering postprandial glucose excursions in individuals with diabetes. There was some evidence for the carbohydrate last meal pattern lowering insulin levels and increasing GLP-1 and GIP levels in individuals with diabetes. The risk of bias ranged from low to some concerns, and the GRADE assessment showed a low certainty of evidence. CONCLUSIONS: Evidence suggests that the carbohydrate last meal pattern effectively reduces postprandial glucose excursions in individuals with diabetes. However, significant heterogeneity in study design limits overall certainty in the findings. Further research is needed to confirm these effects.