The Effect of a Multistrain Probiotic on Metformin Tolerance and Efficacy With Microbiota and Stool Metabolome in Insulin-resistant Women - a 12-week Randomized, Placebo-controlled, Double-blind Study
- Conditions
- Insulin Resistance
- Interventions
- Dietary Supplement: the group GP (placebo)Dietary Supplement: the group GS (probiotic)
- Registration Number
- NCT06092060
- Lead Sponsor
- Poznan University of Physical Education
- Brief Summary
The goal of this study is to evaluate the efficacy of metformin on insulin sensitivity and vascular endothelial function with respect to gut microbiota and metabolome in women with established insulin resistance and its tolerance after 12 weeks of probiotic therapy.
The hypothesis is probiotic therapy in women with established insulin resistance undergoing metformin treatment increases the drug's efficacy to improve insulin sensitivity and intestinal endothelial function, and reduces gastrointestinal side effects.
Study participants will be randomly assigned to 2 groups, taking a probiotic (GS) or a placebo (GP). The randomization scheme will be computer-generated using permuted blocks of block size 4.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 40
- women 25-45 years old, menstruating, BMI 25-32.9 kg / m2, insulin resistance based on the HOMA-IR index (cut-off point 2.5
- type 1 and 2 diabetes,
- poorly controlled arterial hypertension (mean SBP values> 140mmHg and / or mean DBP values> 90mmHg) within the last month and / or the need to modify pharmacological treatment,
- 2nd degree obesity, BMI> 35 kg / m2,
- lipid disorders requiring pharmacological treatment in the last 3 months before the start of observation or during observation,
- positive history of ischemic heart disease, carotid and / or lower limb atherosclerosis,
- features of heart failure on physical examination and / or additional examinations (chest X-ray, echocardiography),
- clinically significant arrhythmias or conduction disturbances,
- chronic kidney disease with creatinine clearance <60mL / min / 1.73m2,
- clinically significant impairment of liver function (transaminase values 3 times the normal range),
- acute or chronic, clinically evident inflammatory process (diseases of connective tissue and joints, inflammatory processes of the respiratory tract, inflammatory processes of the genitourinary system, inflammation of the head and neck),
- acute infection in the last month,
- Cancer,
- alcohol abuse, drug addiction,
- taking medications that may interfere with test results,
- Taking antibiotics, steroids, antifungal and antiparasitic agents 4 weeks before the examination (not applicable to topical antifungal agents).
- taking pre - and / or probiotics in the last 12 weeks before the test
- travel to tropical countries in the last 4 weeks prior to the survey
- other conditions that may pose any risk to the patient during the follow-up.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description the group GP the group GP (placebo) placebo group, ca. 20 participants the group GS the group GS (probiotic) probiotic treatment group, ca. 20 participants
- Primary Outcome Measures
Name Time Method Indicators of a disrupted intestinal barrier in the blood up to 10 months zonulin, intestinal fatty acid binding protein (I-FABP)
Adipokines and myokines up to 10 months Analysis of biochemical indicators related to insulin resistance such as leptin, adiponectin, resistin, wisfatin, retinol-binding protein type 4 (RBP4), lipocalin-2, proprotein convertase subtilisin/kexin type 9 (PCSK9)
Indicators of inflammation up to 10 months C-reactive protein (hsCRP), interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor (TNF-alpha), lipocalin-2
Indicators of insulin sensitivity and carbohydrate metabolism up to 10 months Analysis of biochemical indicators related to insulin resistance such as concentrations of glucose, insulin, insulin-like growth factor (IGF-1), hemoglobin A1C (HgA1C), myoglobin
Evaluation of indicators in stool up to 10 months Determination of intestinal inflammatory index - fecal calprotectin, determination of intestinal permeability index - fecal zonulin and determination of intestinal membrane inflammatory index sIgA in feces (RT-PCR and Western blotting).
Intestinal metabolome in stool samples up to 10 months metabolomic analysis (endogenous metabolism (catabolism of amino acids, lipids), biotransformation products under the influence of xenobiotics (e.g., caffeine), fatty acid biosynthesis, fatty acid derivatives, glycolysis, gluconeogenesis, biosynthesis of primary bile acids, amino acid metabolism, sphingolipid metabolism, unknown metabolites, non-targeted metabolome, short-chain fatty acids) will be performed on a quadrupole mass spectrometer coupled with a time-of-flight (QToF) analyzer connected to the AB Sciex - TripleTOF® 6600+ high performance liquid chromatograph (UHPLC)
Indicators of vascular endothelial function up to 10 months Analysis of biochemical indicators related to insulin resistance and endothelial function, such as endothelial nitric oxide synthase (eNOS), vascular endothelial growth factor (VEGF), homocysteine, plasminogen activator inhibitor 1 (PAI-1), adhesion molecules (sVCAM-1, ICAM-1), monocyte chemoattractant 1(MCP-1), matrix metalloproteinases (MMP-9 and MMP-2), cytosolic fatty acid binding proteins (FABPs)
Qualitative assessment of intestinal microbiota in stool samples up to 10 months gut bacteria species in stool will be assessed using the shallow shotgun sequencing method, NGS (Next Generation Sequencing)
Transcription factors regulating carbohydrate and lipid metabolism up to 10 months Peroxisome proliferator-activated receptor (PPARγ; NR1C3), PPARγ coactivator, coactivator 1 α ( PGC -1α)
Quantitive change in intestinal microbiota in stool samples up to 10 months determination of quantitative (Colony forming units - CFU) changes in bacteria in the stool - the shallow shotgun sequencing method, NGS (Next Generation Sequencing) molecular analysis will be used to assess the changes
Indicators of lipid metabolism up to 10 months Concentrations of total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, oxidatively modified LDL lipoprotein (oxLDL), paraoxonase (PON) activity, proprotein convertase subtilisin/kexin 9 (PCSK-9)
- Secondary Outcome Measures
Name Time Method Body mass analysis (BMI, kg/m^2) up to 10 months determination of body weight and composition using the electrical bioimpedance method
Composite measure of Diet composition assessed by food diaries up to 10 months assessment of protein, fat, carbohydrates, fibre, minerals and vitamins intake using food diaries (grams)
Gastrointestinal disorders questionnaire up to 10 months assessment of gastrointestinal disorders using the Rome IV Questionnaire for adults (selected questions on irritable bowel syndrome, constipation and diarrhea); the statements of the questionnaire relate to frequency and intensity of disorders; higher scores mean worse outcome
Body composition analysis (percent of total body mass up to 10 months assessment of bone, fat and fat-free mass using the electrical bioimpedance method
Trial Locations
- Locations (1)
Poznan University of Physical Education
🇵🇱Poznań, Poland