Effect of Prebiotic on Microbiota, Intestinal Permeability, and Glycemic Control in Children With Type 1 Diabetes

Abstract

Context Patients with type 1 diabetes (T1D) have lower microbiota diversity and distinct gut microbial profiles that have been linked to changes in intestinal permeability. Prebiotics are nondigestible carbohydrates that alter gut microbiota and could potentially improve glycemic control and reduce intestinal permeability and thereby insulin sensitivity. Objective To determine the effect of prebiotics on glycemic control, gut microbiota, and intestinal permeability in children with T1D. Design A randomized, placebo-controlled trial in children 8 to 17 years of age with T1D using placebo or prebiotic oligofructose-enriched inulin for 12 weeks. Baseline, 3-month, and 6-month assessments included HbA1c, C-peptide, gut microbiota, intestinal permeability, frequency of diabetic ketoacidosis (DKA), and severe hypoglycemia. Results Forty-three subjects were randomized and 38 completed the study. The groups were similar at baseline: prebiotic (N = 17), age 12.5 years (SD of 2.8), HbA1c 8.02% (SD of 0.82); placebo (N = 21), age 12.0 years (SD of 2.6), HbA1c 8.08% (SD of 0.91). No significant differences were found in the frequency of DKA or severe hypoglycemia. At 3-months, C-peptide was significantly higher (P = 0.029) in the group who received prebiotics, which was accompanied by a modest improvement in intestinal permeability (P = 0.076). There was a significant increase in the relative abundance of Bifidobacterium within the prebiotic group at 3 months that was no longer present after the 3-month washout. The placebo group had significantly higher relative abundance of Streptococcus, Roseburia inulinivorans, Terrisporobacter, and Faecalitalea compared with 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.

Intestinal Permeability in Children with Celiac Disease after the Administration of Oligofructose-Enriched Inulin into a Gluten-Free Diet—Results of a Randomized, Placebo-Controlled, Pilot Trial

“…Based on these results, we can assume that increased permeability of the intestinal barrier was not observed in our study. Our results are in agreement with the results reported by Ho et al [ 43 ], who reported a lack of effect of prebiotic supplementation on intestinal permeability assessed by SAT in children with type 1 diabetes. Inconsistent results were obtained in the study with obese individuals supplemented with arabinoxylans [ 44 ].…”

“…GFD itself seems not to completely cure the epithelium of CD patients even after many years of adherence, despite the improvement in histological parameters expressed by Marsh scale, which was suggested also in a study evaluating iFABP in adult CD patients [ 51 ]. On the other hand, a recent study with children with type 1 diabetes supplemented with oligofructose-enriched inulin reported only small, non-significant increases in GLP-2, similar to our study [ 43 ].…”

Effect of fructans, prebiotics and fibres on the human gut microbiome assessed by 16S rRNA-based approaches: a review

“…Consumption of this mix was associated with significant reduction of body fat and body weight, significant decrease in serum triglycerides and serum level of interleukin 6 in these children. Another intervention with child Type I diabetes patients using the same inulin mix and dose also increased the relative abundance of Bfidobacteria at 3 months which was gone after a further 3 month washout; there were no improvements in diabetic ketoacidosis although C-peptide was significantly higher and there was a trend for improved intestinal permeability (Ho et al, 2019). Finally the impact of 16 g/d scFOS or GOS on glycemia during oral glucose tolerance test (OGTT) and the intestinal microbiota was studied (Liu et al, 2017a).…”

The Potential Mediation of the Effects of Physical Activity on Cognitive Function by the Gut Microbiome

“…Persons with type 2 diabetes show increased likelihood for gut dysbiosis and greater proportions of pathogens [180]. Improving gut microbiome composition with probiotic supplementation was found to reduce biomarkers associated with metabolic disorders (i.e., fasting glucose, fasting plasma insulin, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR)) [181], and use of prebiotic supplementation has been associated with increased biomarkers indicative of improved metabolic functioning (i.e., C-peptide) [182].…”