Dietary fibre in treatment of diabetes: myth or reality?

Diabetes is a plurimetabolic disease characterised mainly by glucose metabolism abnormalities that lead to the development of acute and long-term complications. Long-term complications are rapidly increasing, which explains the higher mortality due to cardiovascular events in diabetic patients compared to the general population. A poor blood glucose control is known to be an important risk factor for the development of cardiovascular complications, and dietary fibre - particularly the soluble type - plays an important role in controlling plasma glucose concentrations and other risk factors associated with diabetes. Nevertheless, there are still some doubts as to whether it is possible to achieve, in free-living diabetic patients, good compliance to a high fibre diet without using fibre supplements or foods fortified with fibre, and whether the beneficial effects of this diet on blood glucose control, observed in acute or in medium-term studies, are clinically relevant also in the longterm. Recently, a wealth of convincing evidence has confirmed the hypothesis that, in diabetic patients, dietary fibre decreases postprandial plasma glucose, insulin and triglyceride concentrations, and has a clinically relevant hypocholesterolaemic effect. These data also show that: 1) it is possible to increase dietary fibre by consuming exclusively natural foods, with a satisfactory compliance in free-living diabetic patients also in the long-term, due to its minimal side-effects; and 2) the beneficial metabolic effects of dietary fibre are long-lasting and clinically relevant, as shown by the lower plasma glycosylated haemoglobin levels, reduced rate of hypoglycaemic episodes and improved cardiovascular profile both in type 1 and type 2 diabetic patients.