Prebiotics May Improve Glycemic Control in Children With Type 1 Diabetes

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Prebiotic supplementation may serve as an inexpensive and low-risk treatment addition to improve glycemic control in patients with type 1 diabetes.

Prebiotic supplementation may serve as an inexpensive and low-risk treatment addition to improve glycemic control in patients with type 1 diabetes (T1D), according to study results published in The Journal of Clinical Endocrinology & Metabolism.

Impaired intestinal epithelial barrier function was previously described in patients with T1D compared with healthy controls. Differences in the gut microbiota composition between patients with T1D and healthy controls may contribute to metabolic dysregulation and the deterioration of glycemic control. The goal of the study was to examine the effect of adding prebiotic oligofructose-enriched inulin compared with placebo on glycemic control in children with T1D.

The randomized trial enrolled 43 children age 8 to 17 years with T1D for ≥1 year. The participants were randomly assigned to receive placebo or prebiotic oligofructose-enriched inulin for 12 weeks. At baseline, average age and glycemic control were similar in both groups.

Of the 43 patients, 38 completed the study, including 17 participants in the prebiotic group (mean age, 12.5 ± 2.5 years; mean hemoglobin A1c [HbA1c] 8.02% ± 0.82%) and 21 patients in the control group (mean age, 11.9 ± 2.6 years; mean HbA1c, 8.08% ± 0.91%).

There was no difference in the number of adverse events including diabetic ketoacidosis, severe hypoglycemia, and nonsevere hypoglycemia per week between the placebo and prebiotic group.

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While there was no significant decrease in HbA1c with the prebiotic after 12 weeks of treatment, there was an increase in C-peptide in the prebiotic group compared with the placebo group (P =.029), suggesting improved beta-cell function, which may lead to improved glycemic control. Furthermore, this was accompanied by a decrease in intestinal permeability in the prebiotic group, while the placebo group had an increase in intestinal permeability; however, the difference was not statistically different (P =.076).

The relative abundance of Bifidobacterium, and specifically Bifidobacterium longum, was significantly increased after 12 weeks of prebiotics. In the placebo group there was a significantly higher relative abundance of Streptococcus, Roseburia inulinovorans, Terrisporobacter, and Faecalitalea compared with the prebiotic group. However, 3 months after the end of the treatment period, most of these differences disappeared.

“Prebiotic supplementation, specifically oligofructose-enriched inulin, is a potentially novel, inexpensive, low-risk treatment addition for T1D that may improve glycemic control,” concluded the researchers, adding that further large-scale trials are needed.

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Ho J, Nicolucci AC, Virtanen H, et al. Effect of prebiotic on microbiota, intestinal permeability and glycemic control in children with type 1 diabetes [published online June 12, 2019]. J Clin Endocrinol Metab. doi:10.1210/jc.2019-00481