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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.

Author information

1
Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, Canada.
2
Cumming School of Medicine, Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, Canada.
3
International Microbiome Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
4
Cumming School of Medicine, Department of Internal Medicine, University of Calgary, Calgary, Canada.
5
Faculty of Kinesiology, University of Calgary, Calgary, Canada.

Abstract

BACKGROUND:

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.

PURPOSE:

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

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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

PMID:
31188437
DOI:
10.1210/jc.2019-00481

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