Table 2.

Quality of evidence-based on GRADE assessment.

Outcome	Risk of bias	Inconsistencya	Indirectness	Imprecision	Publication biasb	Decision
Insulin sensitivity	Some concerns	Substantial	Some indirectness	Moderate imprecision	Undetected	⊕⊕∅∅ Low
HOMA-IR	Some concerns	Substantial	Some indirectness	Moderate imprecision	Undetected	⊕⊕∅∅ Low
Fasting glucose	Some concerns	Substantial	Some indirectness	Moderate imprecision	Undetected	⊕⊕∅∅ Low
Fasting insulin	Some concerns	Substantial	Some indirectness	Moderate imprecision	Undetected	⊕⊕∅∅ Low
Postprandial glucose	Low	Consistent	No serious indirectness	Moderate imprecision	Undetected	⊕⊕⊕∅ Moderate
Postprandial insulin	Low	Substantial	No serious indirectness	Moderate imprecision	Undetected	⊕⊕⊕∅ Moderate
HbA1c	Some concerns	Moderate	Some indirectness	Moderate imprecision	Undetected	⊕⊕∅∅ Low
Pancreatic beta-cell function	Low	Consistent	No serious indirectness	Moderate imprecision	Undetected	⊕⊕∅∅ Low
GLP-1	Low	Substantial	Some indirectness	Moderate imprecision	Possible	⊕∅∅∅ Very Low

^aBased on I² using thresholds in Cochrane Handbook for Systematic Reviews of Interventions, Version 6. The Cochrane Collaboration, 2019. Available at: https://training.cochrane.org/handbook/current.

^bBased on Egger’s regression.