Which peer‑reviewed meta‑analyses compare raw or monofloral honeys versus sugar for HbA1c in type 2 diabetes?

1. Meta‑analyses that include HbA1c but not the raw/monofloral vs sugar contrast

The most prominent peer‑reviewed meta‑analysis is the Nutrition Reviews systematic review and meta‑analysis that assessed the effect of honey on cardiometabolic risk factors, and which reported effects on fasting glucose and a pooled HbA1c estimate (noting a pooled HbA1c reduction of about 0.25% in some analyses), but the paper pooled diverse honey interventions and trial designs rather than isolating raw or monofloral honey compared head‑to‑head with table sugar in people with type 2 diabetes ^{[1] [2]}. Another systematic review of clinical trials summarized trials of honey in adult patients including those with type 2 diabetes and reported the small number of diabetes‑specific trials and mixed HbA1c findings, but it did not present a dedicated meta‑analysis comparing distinct honey types (raw or monofloral) versus sugar for HbA1c ^{[3] [4]}.

2. What the trial evidence pooled in these reviews actually looks like

The underlying randomized trials that feed those meta‑analyses are few, small, and heterogenous: some diabetes trials showed increases in HbA1c after high daily doses of honey (e.g., 50 g/day for 8 weeks increased HbA1c in a 53‑patient crossover RCT), others showed no change, and one small trial reported HbA1c reductions at low doses (5–25 g/day over months), making pooled estimates unstable and sensitive to single trials ^{[5] [6] [3] [1]}. The Nutrition Reviews meta‑analysis authors explicitly flagged instability in HbA1c estimates in sensitivity analyses (removal of a single trial altered significance), underscoring that pooled HbA1c effects were driven by a small number of heterogeneous studies rather than by consistent head‑to‑head comparisons of particular honey types ^[1].

3. Why “raw” or “monofloral” matters — and why the reviews don’t answer it

Monofloral honeys (from a single floral source) and raw, minimally processed honeys are hypothesized to differ in sugar composition, minor nutrients, polyphenols and glycemic effect, but the published meta‑analyses and systematic reviews identified do not disaggregate trials by floral origin or processing status when reporting HbA1c outcomes; instead, trials are usually described generically as “honey” and dose, duration, and comparator vary, so a meta‑analytic contrast restricted to raw or monofloral honeys versus table sugar for HbA1c is not available in the supplied literature ^{[1] [3] [4]}. The reviews therefore cannot provide a definitive pooled estimate for raw/monofloral honey versus sugar in type 2 diabetes because their constituent trials rarely specified or standardized floral origin or processing ^{[1] [3]}.

4. Bottom line, uncertainties, and what would be needed to answer the precise question

In short, peer‑reviewed meta‑analyses that include HbA1c as an outcome exist (Nutrition Reviews 2023 and prior systematic reviews), but none of the identified meta‑analyses in the provided reporting delivers a dedicated pooled comparison of raw or monofloral honeys versus table sugar for HbA1c in people with type 2 diabetes; the evidence base is small, mixed (some trials show HbA1c rises with high honey doses, others show reductions at low doses), and sensitive to individual studies, so a definitive meta‑analytic answer would require more, larger randomized trials that explicitly compare defined raw or monofloral honey products to quantified sugar comparators and report HbA1c with sufficient duration for change to be meaningful ^{[1] [3] [5] [6]}.