Effect of oats and oat β-glucan on glycemic control in diabetes: a systematic review and meta-analysis of randomized controlled trials

Introduction Current health claims recognize the ability of oat ss-glucan to lower blood cholesterol; however, its ability to improve glycemic control is less certain. We undertook a systematic review and meta-analysis of randomized controlled trials (FICTs) to update the evidence on the effect of oats and oat beta-glucan on glycemic control in individuals with diabetes. Research design and methods MEDLINE, EMBASE and Cochrane were searched (June 2021) for RCTs of >= 2weeks investigating the effect of oat beta-glucan on glycemic control in diabetes. The outcomes were hemoglobin A1c (HbA1c), fasting glucose, 2-hour postprandial glucose (2h-PG) from a 75g oral glucose tolerance test, homeostatic model assessment of insulin resistance (HOMA-IR) and fasting insulin. Independent reviewers extracted the data and assessed the risk of bias. Data were pooled using the generic inverse variance method. Heterogeneity was assessed (Cochran Q) and quantified (I-2). Pooled estimates were expressed as mean difference (MD) with 95% CI. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach. Results Eight trial comparisons (n=407) met the eligibility criteria. All trials were in adults with type 2 diabetes who were predominantly middle-aged, overweight and treated by antihyperglycemic medications or insulin. A median dose of 3.25g of oat beta-glucan for a median duration of 4.5 weeks improved HbA1c (MD, -0.47% (95% CI -0.80 to -0.13), p(MD)=0.006), fasting glucose (-0.75mmol/L (-1.20 to -0.31), p(MD) <0.001), 2h-PG (-0.42 mmol/L (-0.70 to -0.14), p(MD)=0.003) and HOMA-IR (-0.88 (-1.55 to -0.20), p(MD)=0.011). There was a non-significant reduction in fasting insulin (-4.30 pmol/L (-11.96 to 3.35), p(MD)=0.271). The certainty of evidence was high for fasting glucose, moderate for HOMA-IR and fasting insulin (downgraded for imprecision), and low for HbA1c and 2h-PG (downgraded for imprecision and inconsistency). Conclusions Consumption of oats and oat beta-glucan results in generally small improvements in established markers of fasting and postprandial glycemic control beyond concurrent therapy in adults with type 2 diabetes. The current evidence provides a very good indication for reductions in fasting glucose and less of an indication for reductions in HbA1c, 2h-PG, fasting insulin and HOMA-IR in this population.