Inulin-type fructans supplementation improves glycemic control for the prediabetes and type 2 diabetes populations: results from a GRADE-assessed systematic review and dose–response meta-analysis of 33 randomized controlled trials

Abstract

BackgroundCurrently, many clinical trials have shown that inulin-type fructans (ITF) supplementation is associated with glycemic control; nevertheless, the results are inconclusive. The aim of this meta-analysis of randomized controlled trials was to assess the effects of ITF supplementation on glycemic control.MethodsPubMed, EMBASE and the Cochrane Library were searched for eligible articles up to March 6, 2019. A random-effects model was used to analyze the pooled results, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was applied to assess the quality of evidence. The dose–response model was used to recommend the daily dose and duration for ITF supplementation.ResultsThirty-three trials involving 1346 participants were included. Overall, ITF supplementation could significantly reduce concentrations of fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS) and homeostasis model assessment-insulin resistance (HOMA-IR). In the prediabetes and type 2 diabetes (T2DM) population, a more significant reduction in FBG [weighted mean difference (WMD): − 0.60 mmol/l; 95% CI − 0.71, − 0.48 mmol/l; high rate], HbA1c (WMD: − 0.58%; 95% CI − 0.83, − 0.32%; high rate), FINS (WMD: − 1.75 µU/ml; 95% CI − 2.87, − 0.63 µU/ml; low rate), and HOMA-IR (WMD: − 0.69; 95% CI − 1.10, − 0.28; low rate) were observed, and ITF supplementation with a daily dose of 10 g for a duration of 6 weeks and longer was recommended. Moreover, subgroup analyses suggested that the effects of glycemic control were significantly influenced by the sex of the subjects and the type and the method of intake of ITF.ConclusionsOur analyses confirmed that these four main glycemic indicators were significantly reduced by ITF supplementation, particularly in the prediabetes and T2DM population. Evidence supports that reasonable administration of ITF supplementation may have potential clinical value as an adjuvant therapy for prediabetes and T2DM management.Trial registration The trial was registered at PROSPERO as CRD42018115875 on November 23, 2018.

Dietary Supplementation with Inulin Modulates the Gut Microbiota and Improves Insulin Sensitivity in Prediabetes

“…In addition, a meta-analysis showed that inulin-type carbohydrates could improve insulin resistant in T2DM, especially in obese T2DM patients [ 13 ]. Another meta-analysis included 33 RCTs which further demonstrated that inulin-type fructan (ITF) significantly reduced HOMA-IR in prediabetes or T2DM, as well as in healthy subjects [ 17 ].…”

Gut microbiota influence in type 2 diabetes mellitus (T2DM)

“…Prebiotic supplementation is associated with improved glycaemic control however as per with probiotic study reporting, heterogeneity in methodology is also vast resulting in inconclusive literature. Wang et al [ 146 ]., published the most comprehensive meta-analysis to date, which included 33 RCTs involving 1346 participants spread across healthy, obese and T2DM cohorts. Focusing solely on the prediabetic and T2DM cohorts, compared with the control, the relative reduction of the FBG, HbA1c levels, fasting insulin concentration and insulin sensitivity was 7.15, 7.00, 16.58, and 25.34% of their baseline values after supplementation [ 146 ].…”

“…Wang et al [ 146 ]., published the most comprehensive meta-analysis to date, which included 33 RCTs involving 1346 participants spread across healthy, obese and T2DM cohorts. Focusing solely on the prediabetic and T2DM cohorts, compared with the control, the relative reduction of the FBG, HbA1c levels, fasting insulin concentration and insulin sensitivity was 7.15, 7.00, 16.58, and 25.34% of their baseline values after supplementation [ 146 ]. A daily supplement dose greater than 10 g and for a minimum duration of 42 days was recommended for consistent improvement across the glycaemic indicators.…”

Maternal Inulin Supplementation Alters Hepatic DNA Methylation Profile and Improves Glucose Metabolism in Offspring Mice

“…However, recent one study found that C57BL/6J mice fed a HF diet could be susceptible to liver cancer upon consumption of inulin (Singh et al, 2018). In clinical trials, it did not show adverse effects of inulin on liver function in human (Wang et al, 2019). The reason might be the duration of inulin treatment and HF diet.…”