title: Psyllium fiber improves glycemic control proportional to loss of glycemic control: a meta-analysis of data in euglycemic subjects, patients at risk of type 2 diabetes mellitus, and patients being treated for type 2 diabetes mellitus.
abstract: BACKGROUND
  A number of health benefits are associated with intake of soluble, viscous, gel-forming fibers, including reduced serum cholesterol and the attenuation of postprandial glucose excursions.
  
  
  OBJECTIVE
  We assess the effects of psyllium, which is a soluble, gel-forming, nonfermented fiber supplement, on glycemic control in patients who were being treated for type 2 diabetes mellitus (T2DM) and in patients who were at risk of developing T2DM.
  
  
  METHODS
  A comprehensive search was performed of available published literature (Scopus scientific database) and clinical records stored by Procter & Gamble with the use of key search terms to identify clinical studies that assessed the glycemic effects of psyllium in nondiabetic, pre-T2DM, and T2DM patients.
  
  
  RESULTS
  We identified 35 randomized, controlled, clinical studies that spanned 3 decades and 3 continents. These data were assessed in 8 meta-analyses. In patients with T2DM, multiweek studies (psyllium dosed before meals) showed significant improvement in both the fasting blood glucose (FBG) concentration (-37.0 mg/dL; P < 0.001) and glycated hemoglobin (HbA1c) [-0.97% (-10.6 mmol/mol); P = 0.048]. Glycemic effects were proportional to baseline FBG; no significant glucose lowering was observed in euglycemic subjects, a modest improvement was observed in subjects with pre-T2DM, and the greatest improvement was observed in subjects who were being treated for T2DM.
  
  
  CONCLUSIONS
  These data indicate that psyllium would be an effective addition to a lifestyle-intervention program. The degree of psyllium's glycemic benefit was commensurate with the loss of glycemic control. Because the greatest effect was seen in patients who were being treated for T2DM, additional studies are needed to determine how best to incorporate psyllium into existing prevention and treatment algorithms with concomitant hypoglycemic medications.
authors.affiliation: Procter & Gamble Co., Mason, OH; and gibb.rd@pg.com.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Gibb
authors.affiliation: Procter & Gamble Co., Mason, OH; and.
authors.forename: Johnson W
authors.initials: JW
authors.lastname: McRorie
authors.affiliation: Procter & Gamble Co., Mason, OH; and.
authors.forename: Darrell A
authors.initials: DA
authors.lastname: Russell
authors.affiliation: Department of Biostatistics and Bioinformatics and.
authors.forename: Vic
authors.initials: V
authors.lastname: Hasselblad
authors.affiliation: Division of Endocrinology, Metabolism and Nutrition, Duke Department of Medicine, Duke University, Durham, NC.
authors.forename: David A
authors.initials: DA
authors.lastname: D'Alessio
mesh_terms: D003131:Combined Modality Therapy / Q000009:adverse effects; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D019317:Evidence-Based Medicine; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D056692:Prebiotics / Q000009:adverse effects; D011236:Prediabetic State / Q000097:blood / Q000178:diet therapy* / Q000453:epidemiology / Q000517:prevention & control; D011620:Psyllium / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012306:Risk
chemical_list: D006442:Glycated Hemoglobin; D056692:Prebiotics; D011620:Psyllium; C517652:hemoglobin A1c protein, human
keywords: diabetes; fiber; glycemic; glycemic control; meta-analysis; metabolic syndrome; psyllium; type 2 diabetes