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Should Viscous Fiber Supplements Be Considered in Diabetes Control? Results From a Systematic Review and Meta-analysis of Randomized Controlled Trials.
Diabetes Care. 2019 05; 42(5):755-766.DC

Abstract

OBJECTIVE

Evidence from randomized controlled trials (RCTs) suggests that viscous dietary fiber may offer beneficial effects on glycemic control and, thus, an improved cardiovascular disease risk profile. Our purpose was to conduct a systematic review and meta-analysis of RCTs to synthesize the therapeutic effect of viscous fiber supplementation on glycemic control in type 2 diabetes.

RESEARCH DESIGN AND METHODS

MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched through 15 June 2018. We included RCTs ≥3 weeks in duration that assessed the effects of viscous fiber on markers of glycemic control in type 2 diabetes. Two independent reviewers extracted data. Data were pooled using the generic inverse variance method and expressed as mean differences (MD) with 95% CIs. Heterogeneity was assessed (Cochran Q statistic) and quantified (I 2 statistic). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the overall certainty of the evidence.

RESULTS

We identified 28 eligible trial comparisons (n = 1,394). Viscous fiber at a median dose of ∼13.1 g/day significantly reduced HbA1c (MD -0.58% [95% CI -0.88, -0.28]; P = 0.0002), fasting blood glucose (MD -0.82 mmol/L [95% CI -1.32, -0.31]; P = 0.001), and HOMA-insulin resistance (IR) (MD -1.89 [95% CI -3.45, -0.33]; P = 0.02) compared with control and in addition to standard of care. The certainty of evidence was graded moderate for HbA1c, fasting glucose, fasting insulin, and HOMA-IR and low for fructosamine.

CONCLUSIONS

Viscous fiber supplements improve conventional markers of glycemic control beyond usual care and should be considered in the management of type 2 diabetes.

Authors+Show Affiliations

Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada.Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada. Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Canada. Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Canada. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada. Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Canada.Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada.Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada.Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada.Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, University of Zagreb School of Medicine, Zagreb, Croatia.Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada v.vuksan@utoronto.ca. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada. Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Canada. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

30617143

Citation

Jovanovski, Elena, et al. "Should Viscous Fiber Supplements Be Considered in Diabetes Control? Results From a Systematic Review and Meta-analysis of Randomized Controlled Trials." Diabetes Care, vol. 42, no. 5, 2019, pp. 755-766.
Jovanovski E, Khayyat R, Zurbau A, et al. Should Viscous Fiber Supplements Be Considered in Diabetes Control? Results From a Systematic Review and Meta-analysis of Randomized Controlled Trials. Diabetes Care. 2019;42(5):755-766.
Jovanovski, E., Khayyat, R., Zurbau, A., Komishon, A., Mazhar, N., Sievenpiper, J. L., Blanco Mejia, S., Ho, H. V. T., Li, D., Jenkins, A. L., Duvnjak, L., & Vuksan, V. (2019). Should Viscous Fiber Supplements Be Considered in Diabetes Control? Results From a Systematic Review and Meta-analysis of Randomized Controlled Trials. Diabetes Care, 42(5), 755-766. https://doi.org/10.2337/dc18-1126
Jovanovski E, et al. Should Viscous Fiber Supplements Be Considered in Diabetes Control? Results From a Systematic Review and Meta-analysis of Randomized Controlled Trials. Diabetes Care. 2019;42(5):755-766. PubMed PMID: 30617143.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Should Viscous Fiber Supplements Be Considered in Diabetes Control? Results From a Systematic Review and Meta-analysis of Randomized Controlled Trials. AU - Jovanovski,Elena, AU - Khayyat,Rana, AU - Zurbau,Andreea, AU - Komishon,Allison, AU - Mazhar,Nourah, AU - Sievenpiper,John L, AU - Blanco Mejia,Sonia, AU - Ho,Hoang Vi Thanh, AU - Li,Dandan, AU - Jenkins,Alexandra L, AU - Duvnjak,Lea, AU - Vuksan,Vladimir, Y1 - 2019/01/07/ PY - 2018/05/23/received PY - 2018/09/19/accepted PY - 2019/1/9/pubmed PY - 2020/1/22/medline PY - 2019/1/9/entrez SP - 755 EP - 766 JF - Diabetes care JO - Diabetes Care VL - 42 IS - 5 N2 - OBJECTIVE: Evidence from randomized controlled trials (RCTs) suggests that viscous dietary fiber may offer beneficial effects on glycemic control and, thus, an improved cardiovascular disease risk profile. Our purpose was to conduct a systematic review and meta-analysis of RCTs to synthesize the therapeutic effect of viscous fiber supplementation on glycemic control in type 2 diabetes. RESEARCH DESIGN AND METHODS: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched through 15 June 2018. We included RCTs ≥3 weeks in duration that assessed the effects of viscous fiber on markers of glycemic control in type 2 diabetes. Two independent reviewers extracted data. Data were pooled using the generic inverse variance method and expressed as mean differences (MD) with 95% CIs. Heterogeneity was assessed (Cochran Q statistic) and quantified (I 2 statistic). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the overall certainty of the evidence. RESULTS: We identified 28 eligible trial comparisons (n = 1,394). Viscous fiber at a median dose of ∼13.1 g/day significantly reduced HbA1c (MD -0.58% [95% CI -0.88, -0.28]; P = 0.0002), fasting blood glucose (MD -0.82 mmol/L [95% CI -1.32, -0.31]; P = 0.001), and HOMA-insulin resistance (IR) (MD -1.89 [95% CI -3.45, -0.33]; P = 0.02) compared with control and in addition to standard of care. The certainty of evidence was graded moderate for HbA1c, fasting glucose, fasting insulin, and HOMA-IR and low for fructosamine. CONCLUSIONS: Viscous fiber supplements improve conventional markers of glycemic control beyond usual care and should be considered in the management of type 2 diabetes. SN - 1935-5548 UR - https://www.unboundmedicine.com/medline/citation/30617143/Should_Viscous_Fiber_Supplements_Be_Considered_in_Diabetes_Control_Results_From_a_Systematic_Review_and_Meta_analysis_of_Randomized_Controlled_Trials_ L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=30617143 DB - PRIME DP - Unbound Medicine ER -