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
Open accessAbstract
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.Design 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.
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A meta-analysis restricted to US studies of persons with diabetes not using pharmacologic treatment or using oral antihyperglycemic agents did not show a significant increase in accident risk.
“A meta-analysis restricted to US studies of persons with DM not using pharmacologic treatment or using oral antihyperglycemic agents did not show a significant increase in risk of accidents.”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1698]
The meta-analysis methods passage lists glycemic outcomes, and Table 3 includes studies from countries outside the United States. Searches for accidents, accident risk, and pharmacologic treatment found no passage assessing accident risk in the specified treatment groups. The claim therefore cannot be verified from our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredAmong individual studies in the analysis, sulfonylurea use did not significantly increase accident risk.
“Among individual studies included in the analysis, use of SU did not significantly increase the risk of accidents.1696–1698”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1698]
The methods passage describing the eight meta-analyses lists glycemic endpoints, not accidents. A discussion passage addresses hypoglycemia in relation to psyllium but does not report accident risk from sulfonylurea use. Searches for sulfonylureas, accidents, and individual-study accident risk found no passage addressing the claim; page numbers were unavailable in our copy. (LLM, conf=0.76)
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- Authors
- Gibb, R. D., McRorie, J. W., Russell, D. A., Hasselblad, V., & D’Alessio, D. A.
- Affiliations
- Procter & Gamble (United States) (US)
- Duke University (US)
- Corresponding author
- Gibb, Roger D
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2015-12
- Volume
- 102
- Issue
- 6
- Pages
- 1604-1614
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2178033703
- Cited by
- 144
- References
- 48
- Citations by year
- 2026: 7 · 2025: 21 · 2024: 19 · 2023: 18 · 2022: 11 · 2021: 15 · 2020: 9 · 2019: 11 · 2018: 12 · 2017: 17 · 2016: 4
- FWCI
- 1.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Natural Antidiabetic Agents Studies
- Keywords
- psyllium, soluble dietary fiber, dietary fiber supplementation, glycemic control, type 2 diabetes, prediabetes, fasting blood glucose, HbA1c, postprandial blood glucose, lifestyle intervention, hypoglycemic medications
- MeSH terms
- Combined Modality Therapy, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Hyperglycemia, Hypoglycemia, Prediabetic State, Psyllium, Risk, Randomized Controlled Trials as Topic, Evidence-Based Medicine, Prebiotics
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