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

Talia Palacios; Luis Vitetta; Samantha Coulson; Claire D Madigan; Yan Y Lam; Rachel Manuel; David Briskey; Chelsea Hendy; Ji-Nu Kim; Thomas Ishoey; Maria J Soto-Giron; Eric M Schott; Gerardo Toledo; Ian D Caterson

doi:10.3390/nu12072041

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

Journal article

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

Talia Palacios, Luis Vitetta, Samantha Coulson, Claire D Madigan, Yan Y Lam, Rachel Manuel, David Briskey, Chelsea Hendy, Ji-Nu Kim, Thomas Ishoey, …

Nutrients, Vol.12(7), pp.1-15

2020

DOI: https://doi.org/10.3390/nu12072041

PMCID: PMC7400852

PMID: 32660025

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Abstract

prediabetes

type 2 diabetes mellitus

metformin

intestinal microbiota

probiotics

short-chain fatty acids

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.

Details

Title: Targeting the Intestinal Microbiota to Prevent Type 2 Diabetes and Enhance the Effect of Metformin on Glycaemia: A Randomised Controlled Pilot Study
Authors: Talia Palacios (Author) - The University of Sydney
Luis Vitetta (Author) - The University of Sydney
Samantha Coulson (Author) - University of the Sunshine Coast, Queensland, Faculty of Science, Health, Education and Engineering
Claire D Madigan (Author) - The University of Sydney
Yan Y Lam (Author) - Rutgers University
Rachel Manuel (Author) - UNSW Australia
David Briskey (Author) - The University of Queensland
Chelsea Hendy (Author) - The University of Sydney
Ji-Nu Kim (Author) - Solarea Bio Inc.
Thomas Ishoey (Author) - Solarea Bio Inc.
Maria J Soto-Giron (Author) - Solarea Bio Inc.
Eric M Schott (Author) - Solarea Bio Inc.
Gerardo Toledo (Author) - Solarea Bio Inc.
Ian D Caterson (Author) - The University of Sydney
Publication details: Nutrients, Vol.12(7), pp.1-15
Publisher: MDPI AG
Date published: 2020
DOI: 10.3390/nu12072041
ISSN: 2072-6643
PMID: 32660025; PMC7400852
Copyright note: © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Organisation Unit: University of the Sunshine Coast, Queensland
Language: English
Record Identifier: 99482305202621
Output Type: Journal article

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Web Of Science research areas: Nutrition & Dietetics

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