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Review
. 2019 Apr 13;11(4):841.
doi: 10.3390/nu11040841.

A Selective Role of Dietary Anthocyanins and Flavan-3-ols in Reducing the Risk of Type 2 Diabetes Mellitus: A Review of Recent Evidence

Britt Burton-Freeman  1 , Michał Brzeziński  2   3 , Eunyoung Park  4 , Amandeep Sandhu  5 , Di Xiao  6 , Indika Edirisinghe  7
Affiliations
Review

A Selective Role of Dietary Anthocyanins and Flavan-3-ols in Reducing the Risk of Type 2 Diabetes Mellitus: A Review of Recent Evidence

Britt Burton-Freeman et al. Nutrients. .

Abstract

Type 2 diabetes mellitus (T2DM) is the most common form of DM and its prevalence is increasing worldwide. Because it is a progressive disease, prevention, early detection and disease course modification are possible. Diet plays a critical role in reducing T2DM risk. Therapeutic dietary approaches routinely recommend diets high in plant foods (i.e., vegetables, fruits, whole-grains). In addition to essential micronutrients and fiber, plant-based diets contain a wide-variety of polyphenols, specifically flavonoid compounds. Evidence suggests that flavonoids may confer specific benefits for T2DM risk reduction through pathways influencing glucose absorption and insulin sensitivity and/or secretion. The present review assesses the relationship between dietary flavonoids and diabetes risk reduction reviewing current epidemiology and clinical research. Collectively, the research indicates that certain flavonoids, explicitly anthocyanins and flavan-3-ols and foods rich in these compounds, may have an important role in dietary algorithms aimed to address diabetes risk factors and the development of T2DM.

Keywords: diabetes; flavonoids; glucose; glycemic control; insulin; polyphenols.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Path to Diabetes/T2DM: A. normal, non-disease/diabetes state (based on fasting glucose 70–99 mg/dL). B. declining insulin sensitivity/increasing insulin resistance, and increasing concentrations of insulin (hyperinsulinemia) to maintain normal glucose: Opportunity * for early detection and intervention to restore normal insulin sensitivity and decrease beta cell burden. C. pre-diabetes identified (fasting glucose 100–125 mg/dL, [1], hyperinsulinemia insufficient to overcome insulin resistance. Diet and lifestyle intervention prescribed. D. T2DM diagnosed (fasting glucose ≥126 mg/dL or 2-h post glucose ≥140 mg/dL, [1], diet and lifestyle and medications prescribed.
Figure 2
Figure 2
Flavonoid compounds, dietary sources and daily intake range. 1 Aglycone values [25].
Figure 3
Figure 3
Purported mechanisms of action of flavonoids with effects on glucose metabolism: AMPK, AMP-activated protein kinase; CHO, carbohydrate; GK, Glucokinase; GLUT 4, Glucose transporter type 4; GNG, Gluconeogenesis; GS, Glutamine synthetase; IRS-1, Insulin receptor substrate 1; JNK, c-Jun N-terminal kinases; Ox, Oxidative; PI3/AKT, phosphatidylinositol 3-kinase (PI3K) and AKT/Protein Kinase B signaling pathway; SGLT, Sodium-dependent glucose transporter; (+), increase, activation; (−), decrease, inactivation.
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