Reducing postprandial glucose in dietary intervention studies and the magnitude of the effect on diabetes-related risk factors: a systematic review and meta-analysis

Purpose: Reducing postprandial hyperglycemia has beneficial effects on diabetesrelated risk factors, but the magnitude of the reduction needed to achieve such an effect is unknown. To quantify the relationship of acute glucose and insulin postprandial responses with longer-term effects on diabetes-related risk factors by performing a systematic review and meta-analysis of dietary intervention studies. Methods: We systematically searched EMBASE and MEDLINE. Dietary intervention studies among any human population aiming to reduce postprandial glycaemia, with actual measures of postprandial glucose (PPG) and/or insulin (PPI) as acute exposures (incremental area under the curve, iAUC) as well as markers of glucose metabolism (fasting glucose, HbA1c) and insulin sensitivity (fasting insulin, HOMA-IR) after at least 4 weeks of diet intervention as outcomes, were included. Meta-analyses were performed for the effects on acute exposures and on diabetes-related risk factors. The relationship between changes in acute exposures and changes in risk factor outcomes was estimated by meta-regression analyses. Results: Out of the 13004 screened papers, 14 papers with 14 comparisons were included in the quantitative analysis. The dietary interventions acutely reduced mean PPG (mean difference (MD), -0.27 mmol/l; 95% CI, -0.41 to -0.14) but not mean PPI (MD, -7.47 pmol/l; 95% CI, -16.79 to 1.86). No significant overall effects on fasting glucose and insulin. HbA1c was reduced by -0.20% (95%CI -0.35 to -0.05). Changes in acute PPG were significantly associated with changes in fasting plasma glucose (FPG) (per 10% change in PPG: β = 0.085 (95% CI, 0.003, 0.167), k=14), but not with fasting insulin (β = 1.20 (95% CI, -0.32, 2.71), k=12). Changes in acute PPI were not associated with changes in FPG (per 10% change in PPI: β = -0.017 (95% CI, -0.056, 0.022), k=11). Conclusions: Only a limited number of postprandial glucose lowering dietary intervention studies measured acute postprandial exposures to PPG/PPI during the interventions. In this small heterogeneous set of studies, an association was found between the magnitude of the acute postprandial responses and the change in fasting glucose but no other outcomes. More studies are needed to quantify the relationship between acute postprandial changes and long-term effects on risk factors