STAR (Survey for ManagemenT of DiAbetes with FibeR-rich Nutrition Drink): A Pan India Survey to Understand the Physician and Patient Perspective Regarding the Role of Dietary Fiber Supplement in the Management of Type 2 Diabetes
Authors: Sanjay Kalra  , Nitin Kapoor  , Saptarshi Bhattacharya  , Sambit Das  , Neeta Deshpande  , Sunil Kumar Kota  , Shehla Shaikh  , Shehla Shaikh  
Published: August 2023

Objectives: The aim of the STAR survey was to understand the physicians’ knowledge, attitude and perception regarding the role of nutritional dietary fiber supplements in the daily management of type 2 diabetes mellitus (T2DM). It also aimed to compare the changes in glycemic parameters as well as energy and satiety levels between patients taking a high-fiber supplement and those not taking a fiber supplement. Methods: Two cross-sectional pan-India surveys were conducted. The first was among 152 physicians who had >5 years of experience in treating patients with T2DM and treated >50 patients with T2DM per month. A self-administered paper-based questionnaire was used for the survey. The other survey was conducted among 3,042 patients with T2DM who were receiving treatment with antidiabetics. These patients were further categorized into the Horlicks Diabetes Plus (HDP) group, which consisted of 1,524 patients who had consumed the HDP fiber supplement for a minimum of 3 months and the non-HDP group, which included 1,518 patients who had never consumed HDP. Results: Almost all physicians prescribed fiber-rich nutritional supplements to their patients with T2DM and believed that dietary fiber has an important role in managing glycated hemoglobin (HbA1c) values, healthy weight and cholesterol levels. Among the main benefits of HDP seen by physicians were improvement in satiety levels and increase in physical activity, reduction in HbA1c, fasting and postprandial glucose, and reduction in dose and/or number of hypoglycemic medications. All physicians recommended that it was important to increase awareness among patients as well as doctors regarding the benefits of HDP in patients with T2DM. Patients in the HDP group reported a mean decrease of 0.72 in their HbA1c value which was statistically significant at 3 months (8.04 at baseline to 7.32 at 3 months). In contrast, the non-HDP group showed a non-statistically significant decrease of 0.61 in HbA1c from a baseline value of 8.15. Furthermore, patients reported a significant decrease in weight of 3 kg in 3 months from baseline value of 72.11 kg to 69.11 kg. This reduction in weight was observed in 82% patients in the HDP group, while the non-HDP group showed an insignificant weight reduction from a baseline value of 72.14 kg to 71.46 kg in 3 months. About 83% of patients reported feeling full for longer periods of time and 92.62% reported feeling more energetic after starting HDP. The compliance and satisfaction rates with HDP were 96% and 75%, respectively. Conclusion: A high-fiber supplement taken along with patients’ existing antidiabetic treatment plan has the potential to decrease glycemic parameters and weight while increase the satiety and energy levels among patients with T2DM. However, these results need to be evaluated further with long-term clinical studies conducted in the real world.