Diabetes Metab J.  2019 Aug;43(4):422-431. 10.4093/dmj.2018.0090.

Additional Effect of Dietary Fiber in Patients with Type 2 Diabetes Mellitus Using Metformin and Sulfonylurea: An Open-Label, Pilot Trial

• Lee SE
• Choi Y
• Jun JE
• Lee YB
• Jin SM
• Hur KY
• Ko GP
• Lee MK

• KMID: 2455666
• DOI: http://doi.org/10.4093/dmj.2018.0090

Abstract

BACKGROUND
Metformin, sulfonylurea, and dietary fiber are known to affect gut microbiota in patients with type 2 diabetes mellitus (T2DM). This open and single-arm pilot trial investigated the effects of the additional use of fiber on glycemic parameters, insulin, incretins, and microbiota in patients with T2DM who had been treated with metformin and sulfonylurea.
METHODS
Participants took fiber for 4 weeks and stopped for the next 4 weeks. Glycemic parameters, insulin, incretins during mixed-meal tolerance test (MMTT), lipopolysaccharide (LPS) level, and fecal microbiota were analyzed at weeks 0, 4, and 8. The first tertile of difference in glucose area under the curve during MMTT between weeks 0 and 4 was defined as "˜responders' and the third as "˜nonresponders,' respectively.
RESULTS
In all 10 participants, the peak incretin levels during MMTT were higher and LPS were lower at week 4 as compared with at baseline. While the insulin sensitivity of the "˜responders' increased at week 4, that of the "˜nonresponders' showed opposite results. However, the results were not statistically significant. In all participants, metabolically unfavorable microbiota decreased at week 4 and were restored at week 8. At baseline, metabolically hostile bacteria were more abundant in the "˜nonresponders.' In "˜responders,' Roseburia intestinalis increased at week 4.
CONCLUSION
While dietary fiber did not induce additional changes in glycemic parameters, it showed a trend of improvement in insulin sensitivity in "˜responders.' Even if patients are already receiving diabetes treatment, the additional administration of fiber can lead to additional benefits in the treatment of diabetes.

Keyword

Diabetes mellitus, type 2; Dietary fiber; Metformin; Microbiota; Sulfonylurea compounds

MeSH Terms

Bacteria
Diabetes Mellitus, Type 2*
Dietary Fiber*
Gastrointestinal Microbiome
Glucose
Humans
Incretins
Insulin
Insulin Resistance
Metformin*
Microbiota
Sulfonylurea Compounds
Glucose
Incretins
Insulin
Metformin
Sulfonylurea Compounds

Figure

• 

  Fig. 1 Study design. Participants took fiber for 4 weeks and stopped for the next 4 weeks to evaluate restoration. Glycemic parameters, incretin levels during mixed-meal tolerance test (MMTT), and fecal microbiota were analyzed at weeks 0, 4, and 8 to evaluate baseline status, the immediate change after AGIO (Bukwang Pharmaceutical Co. Ltd.) intake, and restoration, respectively.

• 

  Fig. 2 Area under the curves (AUCs) during mixed-meal tolerance test (MMTT) by week. AUCs during MMTT were compared at each week. Differences between each visit were analyzed by use of the Wilcoxon signed-rank test, and multiple comparisons were corrected with Bonferroni's method. There were no statistically significant changes in variables over the study period. GIP, gastric inhibitory polypeptide; GLP, glucagon-like peptide; PYY, peptide YY.

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