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Open AccessArticle

Targeting the Intestinal Microbiota to Prevent Type 2 Diabetes and Enhance the Effect of Metformin on Glycaemia: A Randomised Controlled Pilot Study

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The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia
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Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
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Medlab Clinical, Sydney, NSW 2015, Australia
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Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia
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Department of Biochemistry and Microbiology and New Jersey Institute for Food, Nutrition, and Health, School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ 08901, USA
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School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
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School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD 4072, Australia
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Solarea Bio Inc., Cambridge, MA 02142, USA
*
Author to whom correspondence should be addressed.
Nutrients 2020, 12(7), 2041; https://doi.org/10.3390/nu12072041
Received: 15 June 2020 / Revised: 3 July 2020 / Accepted: 7 July 2020 / Published: 9 July 2020
(This article belongs to the Special Issue Role of Prebiotics and Probiotics in Health and Disease)
Early treatment may prevent or delay the onset of type 2 diabetes mellitus (T2DM) in individuals who are at high risk. Lifestyle interventions and the hypoglycemic drug metformin have been shown to reduce T2DM incidence. The effectiveness of such interventions may be enhanced by targeting environmental factors such as the intestinal microbiota, which has been proven to predict the response to lifestyle interventions and play a part in mediating the glucose-lowering effects of metformin. Shifts in the intestinal microbiota “towards a more balanced state” may promote glucose homeostasis by regulating short-chain fatty acids’ production. This study aimed to investigate the safety and effect of a multi-strain probiotic on glycemic, inflammatory, and permeability markers in adults with prediabetes and early T2DM and to assess whether the probiotic can enhance metformin’s effect on glycaemia. A randomised controlled pilot study was conducted in 60 adults with a BMI ≥ 25 kg/m2 and with prediabetes or T2DM (within the previous 12 months). The participants were randomised to a multi-strain probiotic (L. plantarum, L. bulgaricus, L. gasseri, B. breve, B. animalis sbsp. lactis, B. bifidum, S. thermophilus, and S. boulardii) or placebo for 12 weeks. Analyses of the primary outcome (fasting plasma glucose) and secondary outcomes, including, but not limited to, circulating lipopolysaccharide, zonulin, and short chain fatty acids and a metagenomic analysis of the fecal microbiome were performed at baseline and 12 weeks post-intervention. The results showed no significant differences in the primary and secondary outcome measures between the probiotic and placebo group. An analysis of a subgroup of participants taking metformin showed a decrease in fasting plasma glucose, HbA1c, insulin resistance, and zonulin; an increase in plasma butyrate concentrations; and an enrichment of microbial butyrate-producing pathways in the probiotic group but not in the placebo group. Probiotics may act as an adjunctive to metformin by increasing the production of butyrate, which may consequently enhance glucose management. View Full-Text
Keywords: prediabetes; type 2 diabetes mellitus; metformin; intestinal microbiota; probiotics; short-chain fatty acids prediabetes; type 2 diabetes mellitus; metformin; intestinal microbiota; probiotics; short-chain fatty acids
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MDPI and ACS Style

Palacios, T.; Vitetta, L.; Coulson, S.; Madigan, C.D.; Lam, Y.Y.; Manuel, R.; Briskey, D.; Hendy, C.; Kim, J.-N.; Ishoey, T.; Soto-Giron, M.J.; Schott, E.M.; Toledo, G.; Caterson, I.D. Targeting the Intestinal Microbiota to Prevent Type 2 Diabetes and Enhance the Effect of Metformin on Glycaemia: A Randomised Controlled Pilot Study. Nutrients 2020, 12, 2041. https://doi.org/10.3390/nu12072041

AMA Style

Palacios T, Vitetta L, Coulson S, Madigan CD, Lam YY, Manuel R, Briskey D, Hendy C, Kim J-N, Ishoey T, Soto-Giron MJ, Schott EM, Toledo G, Caterson ID. Targeting the Intestinal Microbiota to Prevent Type 2 Diabetes and Enhance the Effect of Metformin on Glycaemia: A Randomised Controlled Pilot Study. Nutrients. 2020; 12(7):2041. https://doi.org/10.3390/nu12072041

Chicago/Turabian Style

Palacios, Talia; Vitetta, Luis; Coulson, Samantha; Madigan, Claire D.; Lam, Yan Y.; Manuel, Rachel; Briskey, David; Hendy, Chelsea; Kim, Ji-Nu; Ishoey, Thomas; Soto-Giron, Maria J.; Schott, Eric M.; Toledo, Gerardo; Caterson, Ian D. 2020. "Targeting the Intestinal Microbiota to Prevent Type 2 Diabetes and Enhance the Effect of Metformin on Glycaemia: A Randomised Controlled Pilot Study" Nutrients 12, no. 7: 2041. https://doi.org/10.3390/nu12072041

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