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SYSTEMATIC REVIEW article

Front. Nutr.
Sec. Nutrition and Metabolism
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1528383
This article is part of the Research Topic Nutraceuticals and Functional Foods in Chronic Disease Prevention and Treatment View all 3 articles

Effects of apple cider vinegar on glycemic control and insulin sensitivity in type 2 diabetes patients: a GRADE-assessed systematic review and dose-response meta-analysis of controlled clinical trials

Provisionally accepted
Donya Arjmandfard Donya Arjmandfard 1*Mehrdad Behzadi Mehrdad Behzadi 1,2Zahra Sohrabi Zahra Sohrabi 3*Mohsen Mohammadi Sartang Mohsen Mohammadi Sartang 3*
  • 1 Student Research Committee, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran, Shiraz, Iran
  • 2 Shiraz University of Medical Sciences, Shiraz, Iran
  • 3 Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran

The final, formatted version of the article will be published soon.

    Background and aims: Diabetes mellitus (DM) is a multifactorial metabolic disorder that affects the body's ability to regulate blood sugar levels. Apple cider vinegar (ACV) could possibly improve diabetes; Nevertheless, evidences provide conflicting results. This study aimed to evaluate the effects of ACV on glycemic profile in type 2 diabetes patients (T2DM) in controlled trials (CTs) by systematically reviewing and dose-response meta-analysis.The Scopus, PubMed, and Web of Science databases were searched until November 2024 according to a systematic approach. All CTs investigating ACV's effects on glycemic factors were included. We used a random-effects model to calculate WMDs and 95% confidence intervals (CIs). The present study assessed publication bias, sensitivity analysis, meta-regression, and heterogeneity based on standard methods. We assessed the bias risk of the included studies using Cochrane quality assessments and used GRADE (Grading of Recommendations Assessment, Development, and Evaluation) to calculate evidence certainty. We registered the study protocol at Prospero (no. CRD42023457493).Results: Overall, we included seven studies in this meta-analysis. ACV significantly reduced fasting blood sugar (FBS) (WMD: -21.929 mg/dl, 95% CI: -29.19, -14.67, P <0.001) and HbA1c (WMD: -1.53 %, 95% CI: -2.65, -0.41, P =0.008) and increased insulin (WMD: 2.059 µu/ml, 95% CI: 0.26, 3.86, P =0.025), while it did not affect hemostatic model assessment for insulin resistance (HOMA-IR). We observed linear and non-linear associations between ACV consumption and FBS levels (P <0.001). Each 1 ml/day increase in ACV consumption was associated with a -1.255 mg/dl reduction in FBS. Moreover, greater effects on FBS were in dosages >10.Conclusions: ACV had positive effects on FBS and HbA1c in T2DM patients.

    Keywords: Apple cider vinegar, FBS, HbA1c, T2DM, Meta-analysis

    Received: 14 Nov 2024; Accepted: 10 Jan 2025.

    Copyright: © 2025 Arjmandfard, Behzadi, Sohrabi and Mohammadi Sartang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Donya Arjmandfard, Student Research Committee, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran, Shiraz, Iran
    Zahra Sohrabi, Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
    Mohsen Mohammadi Sartang, Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.