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Gwang Pyo Ko  (Ko GP) 1 Article
Clinical Diabetes & Therapeutics
Additional Effect of Dietary Fiber in Patients with Type 2 Diabetes Mellitus Using Metformin and Sulfonylurea: An Open-Label, Pilot Trial
Seung-Eun Lee, Yongbin Choi, Ji Eun Jun, You-Bin Lee, Sang-Man Jin, Kyu Yeon Hur, Gwang Pyo Ko, Moon-Kyu Lee
Diabetes Metab J. 2019;43(4):422-431.   Published online April 23, 2019
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  • 9 Web of Science
  • 8 Crossref
AbstractAbstract PDFPubReader   

Metformin, sulfonylurea, and dietary fiber are known to affect gut microbiota in patients with type 2 diabetes mellitus (T2DM). This open and single-arm pilot trial investigated the effects of the additional use of fiber on glycemic parameters, insulin, incretins, and microbiota in patients with T2DM who had been treated with metformin and sulfonylurea.


Participants took fiber for 4 weeks and stopped for the next 4 weeks. Glycemic parameters, insulin, incretins during mixed-meal tolerance test (MMTT), lipopolysaccharide (LPS) level, and fecal microbiota were analyzed at weeks 0, 4, and 8. The first tertile of difference in glucose area under the curve during MMTT between weeks 0 and 4 was defined as ‘responders’ and the third as ‘nonresponders,’ respectively.


In all 10 participants, the peak incretin levels during MMTT were higher and LPS were lower at week 4 as compared with at baseline. While the insulin sensitivity of the ‘responders’ increased at week 4, that of the ‘nonresponders’ showed opposite results. However, the results were not statistically significant. In all participants, metabolically unfavorable microbiota decreased at week 4 and were restored at week 8. At baseline, metabolically hostile bacteria were more abundant in the ‘nonresponders.’ In ‘responders,’ Roseburia intestinalis increased at week 4.


While dietary fiber did not induce additional changes in glycemic parameters, it showed a trend of improvement in insulin sensitivity in ‘responders.’ Even if patients are already receiving diabetes treatment, the additional administration of fiber can lead to additional benefits in the treatment of diabetes.


Citations to this article as recorded by  
  • Advances in the mechanism of metformin with wide-ranging effects on regulation of the intestinal microbiota
    Yue Wang, Xianxian Jia, Bin Cong
    Frontiers in Microbiology.2024;[Epub]     CrossRef
  • The effects of prebiotics on gastrointestinal side effects of metformin in youth: A pilot randomized control trial in youth-onset type 2 diabetes
    Sydney A. Dixon, Sidharth Mishra, Katrina B. Dietsche, Shalini Jain, Lilian Mabundo, Michael Stagliano, Andrea Krenek, Amber Courville, Shanna Yang, Sara A. Turner, Abby G. Meyers, Doris E. Estrada, Hariom Yadav, Stephanie T. Chung
    Frontiers in Endocrinology.2023;[Epub]     CrossRef
  • The impact of dietary, surgical, and pharmacological interventions on gut microbiota in individuals with diabetes mellitus: A systematic review
    Patricia M. Bock, Andreza F. Martins, Rafaela Ramalho, Gabriela H. Telo, Gabriel Leivas, Clara K. Maraschin, Beatriz D. Schaan
    Diabetes Research and Clinical Practice.2022; 189: 109944.     CrossRef
  • Assessment of the safety and probiotic properties of Roseburia intestinalis: A potential “Next Generation Probiotic”
    Chao Zhang, Kejia Ma, Kai Nie, Minzi Deng, Weiwei Luo, Xing Wu, Yujun Huang, Xiaoyan Wang
    Frontiers in Microbiology.2022;[Epub]     CrossRef
  • The Effect of Prebiotics and Oral Anti-Diabetic Agents on Gut Microbiome in Patients with Type 2 Diabetes: A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials
    Omorogieva Ojo, Xiaohua Wang, Osarhumwese Osaretin Ojo, Joanne Brooke, Yiqing Jiang, Qingqing Dong, Trevor Thompson
    Nutrients.2022; 14(23): 5139.     CrossRef
  • The Effect of Dietary Interventions on Chronic Inflammatory Diseases in Relation to the Microbiome: A Systematic Review
    Carlijn A. Wagenaar, Marieke van de Put, Michelle Bisschops, Wendy Walrabenstein, Catharina S. de Jonge, Hilde Herrema, Dirkjan van Schaardenburg
    Nutrients.2021; 13(9): 3208.     CrossRef
  • The Role of Dietary Fibre in Modulating Gut Microbiota Dysbiosis in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials
    Omorogieva Ojo, Qian-Qian Feng, Osarhumwese Osaretin Ojo, Xiao-Hua Wang
    Nutrients.2020; 12(11): 3239.     CrossRef
  • High Fiber and Beta Carotene from Sweet Potatoes and Pumpkin Improve Insulin Resistance by Inhibition of Sterol Regulatory Binding Protein 1c in Liver of Hypertriglyceridemic Rats
    Sunarti Sunarti, Umar Santoso, Abrory Agus Cahya Pramana, Emy Huriyati, Dianandha Septiana Rubi
    Open Access Macedonian Journal of Medical Sciences.2020; 8(A): 898.     CrossRef

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