Effects of fiber supplementation on glycemic excursions and incidence of hypoglycemia in children with type 1 diabetes

Abstract

BackgroundNutritional therapy is an important component of diabetes management. There is data to suggest that fiber content of foods may affect glycemic response.Materials and methods10 children, diagnosed with type 1 diabetes, participated. In the first phase of the study, children followed their usual meal plan. In the second phase, subjects followed the same meal plan except that fiber was added to the diet using a powder supplement (wheat dextrin). Data was collected using a continuous glucose monitoring device. The blood glucose excursion level following each meal was compared between the two phases of the study by fitting a repeated measures regression model. The incidence of hypoglycemia was also compared by fitting a logistic regression model.ResultsThere was no difference in the mean blood glucose excursion after meals or the incidence of hypoglycemia between the two phases. There was a strong negative correlation between the amount of fiber supplemented and the mean maximum post-prandial blood sugar after the lunch and breakfast meals (Spearman rank correlation coefficient = −0.86 lunch and −0.76 breakfast).ConclusionOur study did not show an overall decrease in glucose excursion or incidence of hypoglycemia with fiber supplementation. We did find a strong negative correlation between the amount of fiber added during the supplemental phase and the mean maximum post-prandial blood sugar after the lunch and breakfast meals. We speculate that different types of fiber may have different effects on blood glucose with wheat dextrin having a greater dampening effect.

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“…Specifically, evidence suggests that dietary fiber might be associated with reduced PP glucose and insulin levels due to delayed gastric emptying from added viscosity [ 48 ]. Nine studies addressed this topic [ 47 , 48 , 51 , 59 , 60 , 61 , 62 , 63 , 64 ], with five including patients with T1D [ 48 , 59 , 60 , 61 , 62 ], four including patients with T2D [ 47 , 51 , 63 , 64 ], and one involving healthy individuals [ 64 ]. Findings regarding the effect of dietary fiber consumption on PP blood glucose were generally consistent, with seven studies showing positive effects in patients with T1D [ 9 , 60 , 62 ] and T2D [ 7 , 51 , 63 , 64 ], and two studies showing no effect [ 48 , 61 ] in patients with T1D.…”

“…Yet, there were no differences in the prevalence of nocturnal hypoglycemia. In a crossover study in the U.S. including patients with T1D ( n = 10; mean age = 11.2 years) [ 60 ], Nader et al reported no differences in PP mean blood glucose excursions and incidence of hypoglycemia with and without fiber supplementation, although the authors found a strong negative correlation between the amount of fiber supplemented and the mean maximum PP blood glucose after lunch and breakfast. Similarly, a randomized controlled trial in Italy including patients with T1D ( n = 54, mean age = 28 years) [ 62 ] lasting for 24 weeks found that a high-fiber diet improved glycemic control by decreasing mean daily blood glucose concentrations and the number of hypoglycemic episodes compared to a low-fiber diet.…”

“…Fiber could also potentially reduce digestion and absorption of carbohydrates by reducing accessibility to digestive enzymes such as α-amylase [ 51 , 61 , 62 ]. Additionally, the breakdown of fiber could stimulate insulin secretion and improve insulin sensitivity, decreasing blood glucose levels [ 51 , 60 ]. Lastly, fiber could improve satiety and suppress appetite due to “bulking action” [ 47 ].…”

“…Some but not all evidence suggests that dietary fat and protein could delay and increase glycemic response, therefore increasing insulin needs [ 40 , 41 , 42 , 44 ]. There are inconsistent findings regarding the effect of dietary fiber intake on glycemic control in patients with T1D [ 48 , 59 , 60 , 61 , 62 ], while some evidence shows fiber might be beneficial for PP blood glucose parameters among those with T2D [ 47 , 51 , 63 , 64 ]. Reviewed studies show that carbohydrate-last food order may improve PP glucose profile [ 9 , 46 , 52 , 53 , 68 ].…”