Abstract
PurposeFindings from randomized controlled trials (RCTs) evaluating the effect of pulse intake on glycemic control are inconsistent and conclusive evidence is lacking. The aim of this study was to systematically review the impact of pulse consumption on post-prandial and long-term glycemic control in adults with and without type 2 diabetes (T2D).MethodsDatabases were searched for RCTs, reporting outcomes of post-prandial and long-term interventions with different pulse types on parameters of glycemic control in normoglycemic and T2D adults. Effect size (ES) was calculated using random effect model and meta-regression was conducted to assess the impact of various moderator variables such as pulse type, form, dose, and study duration on ES.ResultsFrom 3334 RCTs identified, 65 studies were eligible for inclusion involving 2102 individuals. In acute RCTs, pulse intake significantly reduced peak post-prandial glucose concentration in participants with T2D (ES – 2.90; 95%CI – 4.60, – 1.21; p ≤ 0.001; I2 = 93%) and without T2D (ES – 1.38; 95%CI – 1.78, – 0.99; p ≤ 0.001; I2 = 86%). Incorporating pulse consumption into long-term eating patterns significantly attenuated fasting glucose in normoglycemic adults (ES – 0.06; 95%CI – 0.12, 0.00; p ≤ 0.05; I2 = 30%). Whereas, in T2D participants, pulse intake significantly lowered fasting glucose (ES – 0.54; 95%CI – 0.83, – 0.24; p ≤ 0.001; I2 = 78%), glycated hemoglobin A1c (HbA1c) (ES – 0.17; 95%CI – 0.33, 0.00; p ≤ 0.05; I2 = 78) and homeostatic model assessment of insulin resistance (HOMA-IR) (ES – 0.47; 95%CI – 1.25, – 0.31; p ≤ 0.05; I2 = 79%).ConclusionPulse consumption significantly reduced acute post-prandial glucose concentration > 1 mmol/L in normoglycemic adults and > 2.5 mmol/L in those with T2D, and improved a range of long-term glycemic control parameters in adults with and without T2D.PROSPERO registry number(CRD42019162322).
Highlights
American Diabetes Association (ADA) American diabetes association area under the curves (AUCs) Area under the curve CHO Carbohydrates confidence intervals (CI) Confidence interval European Association for the Study of Diabetes (EASD) European association for the study of diabetes ES Effect size glycemic index (GI) Glycemic index HbA1c Glycated hemoglobin A1c homeostatic model assessment of insulin resistance (HOMA-IR) Homeostatic model assessment of insulin resistance post-prandial glycemic responses (PPGR) Post-prandial glucose response prediction intervals (PI) Prediction intervals randomized controlled trials (RCTs) Randomized controlled trials shortchain fatty acids (SCFA) Short-chain fatty acids type 2 diabetes (T2D) Type 2 diabetes
In this systematic review and meta-analysis, we found that pulse intake enhances glycemic regulation on both acute post-prandial responses and long-term glycemic indices
We demonstrate that pulse intake leads to clinically significant reductions in PPGRs, with a mean reduction of PPGR > 1 mmol/L in normoglycemic individuals, and > 2.5 mmol/L in those with T2D, and significantly reduced insulin was observed ≥ 20 mIU/L
Summary
ADA American diabetes association AUC Area under the curve CHO Carbohydrates CI Confidence interval EASD European association for the study of diabetes ES Effect size GI Glycemic index HbA1c Glycated hemoglobin A1c HOMA-IR Homeostatic model assessment of insulin resistance PPGR Post-prandial glucose response PI Prediction intervals RCTs Randomized controlled trials SCFA Short-chain fatty acids T2D Type 2 diabetes. The review was published in 2009 and only long-term trials were included in their review. Considering that there are more than 20 long-term trials published since 2009 and given the lack of summarized evidence on post-prandial glucose response after intake of pulses, the aim of the current systematic review is to update the evidence on long-term effects of pulse consumption on glycemic indices as well as integrate the acute glucose response along from RCTs on individuals with and without T2D
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