Diabetes Care and Education

Higher Fiber
(HF) (g/d):
50 grams
(25 g soluble, 25 g insoluble)

Lower Fiber (LF) (g/d)
24 grams
8 g soluble
16 g insoluble

13 subjects (12 men, 1 woman)
with type 2 diabetes

Baseline HbA1c^d:
6%-9.8%

Mean age:
61 y

Mean duration of diabetes:
Onset in most patients after
40 y

Glycemic

• HbA1c: No significant difference between groups (HF 6.9% vs LF 7.2% )
• 24-h area under glucose curve: 10% lower with HF vs LF (P=0.02)
• 24-h area under insulin curve:
  12% lower with HF than LF (P=0.05

Lipidemic

• Total cholesterol: HF 196 mg/dL^e vs LF 210 mg/dL^e (P=0.02)
• Triglycerides: HF 184 mg/dL^f vs LF 205 mg/dL^f (P=0.02)
• HDL^g and LDL^h: No significant differences between groups

Higher Fiber (HF) (g/d):
44

Lower Fiber (LF) (g/d)
16

14 subjects (9 men, 5 women)
with type 2 diabetes

Baseline HbA1c:
5.9%

Mean age:
69 y

Mean duration of diabetes:
3 y

Glycemic

• HbA1c: No significantdifference between groups (HF 5.3% vs LF 5.2%)
• Fasting blood glucose: HF 113 mg/dLi vs LF 121mg/dLⁱ (P=0.01)

Lipidemic

• Total cholesterol: HF 213 mg/dLe vs 221 mg/ dL^e (P=0.025)
• LDL: HF 161 mg/dLe vs 169 mg/dL^e (P=0.025)
• HDL and triglycerides:
  No significant differences

Higher Fiber (HF) (g/d):
50

Lower Fiber (LF) (g/d)
15

54 subjects with type 1
diabetes completed the study
(21 men, 33 women)

Baseline HbA1c:
<10%

Mean age:
28 y

Mean duration of diabetes:
10 y

Glycemic

• HbA1c (intent-to-treat analysis, 63 subjects): No significant difference between groups (HF 8.8% vs LF 9.1%)
• HbA1c (compliant group, 46 subjects): HF 8.6% vs LF 9.1%) (P=0.05)
• Mean daily plasma glucose: Decreased 9%-15% both groups, with no significant difference between groups

Lipidemic

• No effect of diet observed for either
  intent-to-treat analysis or compliant group analysis

Higher Fiber (HF) (g/d):
60

Lower Fiber (LF) (g/d)
20

10 subjects (6 boys, 4 girls
with type 1 diabetes

Mean baseline glycosylated
hemoglobin: 11.4%

Mean age:
14.1 y

Mean duration of diabetes:
4.7 y

Glycemic

• Glycosylated hemoglobin:
  no significant difference between
  groups (HF 10.6% vs LF 11.6%)
• Overall daily blood glucose:
  HF 129 mg/ dLⁱ vs vs LF 162 mg/
  dLⁱ (P=0.01)
• Postprandial blood glucose (mean of values 2 h after 3 main meals): HF 153 mg/dLⁱ vs LF 220 mg/ dLⁱ (P=0.001)

Lipidemic

• Not a study outcome

Higher Fiber (HF) (g/d):
High soluble fiber: 32.9
(includes 14.3 g soluble
fiber)

High insoluble fiber: 33.6
(includes 2 g soluble fiber)

Lower Fiber (LF) (g/d)
6.7 (includes 2 g soluble
fiber)

10 subjects (6 men, 4 women)
with type 2 diabetes

Mean glycosylated
hemoglobin: 8.2%

Mean age:
54 y

Mean duration of diabetes:
2.9 y

Glycemic

• Blood glucose significantly lower 30
  and 60 min after, and serum insulin
  significantly lower 60 min after high soluble fiber meal vs other two meals

Lipidemic

• Not a study outcome

Figure 2: Exercise recommendations for general health and diabetes management and prevention.

• ^aAdapted with permission from the American Dietetic Association’s Evidence Analysis Library (Diabetes Type 1 and 2; Diabetes and Carbohydrates; Evidence Analysis Question: What is the relationship between fiber and metabolic outcomes
  in persons with type 1 and type 2 diabetes?) (11).
• ^bIncludes studies from 1980 to present in which both higher and lower fiber interventions were similar for the percentages of energy as carbohydrate, fat, and protein.
• ^cEnd of study between-group comparisons.
• ^dHbA1c=glycosylated hemoglobin
• ^eTo convert mg/dL cholesterol to mmol/L, multiply mg/dL by 0.0259. To convert mmol/L cholesterol to mg/dL, multiply mmol/L by 38.6. Cholesterol of 193 mg/dL=5.00 mmol/L.
• ^fTo convert mg/dL triglyceride to mmol/L, multiply mg/dL by 0.0113. To convert mmol/L triglyceride to mg/dL, multiply mmol/L by 88.6. Triglyceride of 159 mg/dL=1.80 mmol/L.
• ^gHDL=high-density lipoprotein cholesterol.
• ^hLDL=low-density lipoprotein cholesterol.
• ⁱTo convert mg/dL glucose to mmol/L, multiply mg/dL by 0.0555. To convert mmol/L glucose to mg/dL, multiply mmol/L by 18.0. Glucose of 108 mg/dL=6.0 mmol/L.