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

Background: Currently, 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.

Methods: PubMed, 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.

Results: Thirty-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.

Conclusions: Our 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.

Keywords: Glycemic control; Inulin-type fructans supplementation; Meta-analysis; Prediabetes; Type 2 diabetes.

Fig. 1

PRISMA flowchart indicating studies identified by and included in the systematic review

Fig. 2

Forest plot displaying the effects of inulin-type fructans on fasting blood glucose (mmol/l) by subgroup

Fig. 3

Forest plot displaying the effects of inulin-type fructans on glycosylated hemoglobin (%) by subgroup

Fig. 4

Forest plot displaying the effects of inulin-type fructans on fasting insulin (μU/ml) by subgroup

Fig. 5

Forest plot displaying the effects of inulin-type fructans on homeostasis model assessment-insulin resistance (arbitrary units) by subgroup

Fig. 6

a analysis between dose of inulin-type fructans and FBG net change level; b analysis between duration of inulin-type fructans and FBG net change level; c analysis between total dosage of inulin-type fructans and FBG net change level; d analysis between dose of inulin-type fructans and HbA1c net change level; e analysis between duration of inulin-type fructans and HbA1c net change level; f analysis between total dosage of inulin-type fructans and HbA1c net change level; g analysis between dose of inulin-type fructans and FINS net change level; h analysis between duration of inulin-type fructans and FINS net change level; i analysis between total dosage of inulin-type fructans and FINS net change level; j analysis between dose of inulin-type fructans and HOMA-IR net change level; k analysis between duration of inulin-type fructans and HOMA-IR net change level; l analysis between total dosage of inulintype fructans and HOMA-IR net change level.