Effect of carnosine or β-Alanine supplementation on markers of glycemic control and insulin resistance in humans and animals: a systematic review and meta-analysis

There is growing evidence that supplementation with carnosine, or its rate-limiting precursor β-alanine, can ameliorate aspects of metabolic dysregulation that occur in diabetes and its related conditions. The purpose of this systematic review and meta-analysis was to evaluate the effect of carnosine or β-alanine supplementation on markers of glycemic control and insulin resistance in humans and animals. We performed a systematic search of 6 electronic databases up to 31 December 2020. Primary outcomes were changes in 1) fasting glucose, 2) glycated hemoglobin (HbA1c), and 3) 2-h glucose following a glucose-tolerance test. A set of additional outcomes included fasting insulin and homeostatic model assessment of β-cell function (HOMA-β) and insulin resistance (HOMA-IR). We assessed risk of bias using the Cochrane risk of bias (RoB) 2.0 (human studies) and the Systematic Review Center for Laboratory Animal Experimentation (SYRCLE) RoB (animal studies) tools; and used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess certainty. We used Bayesian hierarchical random-effects models, with informative priors for human data and noninformative priors for animal data. Inferences were made on posterior samples generated by Hamiltonian Markov Chain Monte Carlo using 90% credible intervals (90% CrI) and calculated probabilities. Twenty studies (n = 4 human, n = 16 rodent) were included, providing data for 2 primary outcomes (fasting glucose and HbA1c) and 3 additional outcomes (fasting insulin, HOMA-β, and HOMA-IR). The model provides evidence that supplementation decreases fasting glucose [humans: Mean difference (MD)0.5 =-0.95 mmol · L-1 (90% CrI:-2.1, 0.08); rodent: MD0.5 =-2.26 mmol · L-1 (90% CrI:-4.03,-0.44)], HbA1c [humans: MD0.5 =-0.91% (90% CrI:-1.46,-0.39); rodents: MD0.5 =-1.05% (90% CrI:-1.64,-0.52)], HOMA-IR [humans: Standardized mean difference (SMD)0.5 =-0.41 (90% CrI:-0.82,-0.07); rodents: SMD0.5 =-0.63 (90% CrI:-1.98, 0.65)], and fasting insulin [humans: SMD0.5 =-0.41 (90% CrI:-0.77,-0.07)]. GRADE assessment showed our certainty in the effect estimate of each outcome to be moderate (human outcomes) or very low (rodent outcomes). Supplementation with carnosine or β-alanine may reduce fasting glucose, HbA1c, and HOMA-IR in humans and rodents, and fasting insulin in humans; both compounds show potential as therapeutics to improve glycemic control and insulin resistance. This review was registered at PROSPERO as CRD42020191588