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J Clin Endocrinol Metab. 2019 Jun 12. pii: jc.2019-00481. doi: 10.1210/jc.2019-00481. [Epub ahead of print]

Effect of prebiotic on microbiota, intestinal permeability and glycemic control in children with type 1 diabetes.

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Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, Canada.
Cumming School of Medicine, Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, Canada.
International Microbiome Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Cumming School of Medicine, Department of Internal Medicine, University of Calgary, Calgary, Canada.
Faculty of Kinesiology, University of Calgary, Calgary, Canada.



Patients with type 1 diabetes (T1D) have lower microbiota diversity and distinct gut microbial profiles that have been linked to changes in intestinal permeability (IP). Prebiotics are non-digestible carbohydrates that alter gut microbiota and could potentially improve glycemic control, reduce IP and thereby insulin sensitivity.


To determine the effect of prebiotic on glycemic control, gut microbiota, and IP in children with T1D.


A randomized, placebo controlled trial in children 8-17 years with T1D using placebo or prebiotic oligofructose-enriched inulin for 12 weeks. Baseline, 3-months, and 6-months assessments included: A1C, C-peptide, gut microbiota, IP, frequency of diabetic ketoacidosis (DKA), and severe hypoglycemia.


43 subjects were randomized and 38 completed the study. The groups were similar at baseline: prebiotic (N=17), age 12.5 years (SD 2.8), A1C 8.02% (SD 0.82); placebo (N=21), age 12.0 years (SD 2.6), A1C 8.08% (SD 0.91). No significant differences were found in frequency of DKA or severe hypoglycemia. At 3-months, c-peptide was significantly higher (p=0.029) in the group that received prebiotics, which was accompanied by a modest improvement in IP (p=0.076). There was a significant increase in the relative abundance of Bifidobacterium within the prebiotic group at 3-months which was no longer present after the 3 month wash out. The placebo group had significantly higher relative abundance of Streptococcus, Roseburia inulinovorans, Terrisporobacter and Faecalitalea compared to the prebiotic group at 3 months.


Prebiotics are a potentially novel, inexpensive, low-risk treatment addition for T1D that may improve glycemic control. Further larger scale trials are needed.


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