Dietary Intervention Modifies Gut Microbiota in Type 2 Diabetes.
Primary Purpose
Type 2 Diabetes Mellitus
Status
Completed
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
dietary portfolio
Sponsored by
About this trial
This is an interventional treatment trial for Type 2 Diabetes Mellitus focused on measuring gut microbiota, functional foods, branched chain amino acids, TMAO, type 2 diabetes
Eligibility Criteria
Inclusion Criteria:
- clinical diagnosis of type 2 diabetes
- Male or female.
- Adults between 30 and 60 years old.
- BMI of 25 to 39.9 kg / m².
- Pharmacological treatment with metformin, a combination of metformin and glibenclamide.
- Evolution of the type 2 diabetes of 4 ± 3 years.
- Patients who knew how to read and write.
- Signature of informed consent.
Exclusion Criteria:
- Diseases that produce secondary obesity.
- Cardiovascular event.
- Weight loss> 3 kg in the last 3 months after the evaluation of the criteria.
- Catabolic diseases such as cancer and acquired immunodeficiency syndrome.
- Gravidity status.
- Positive smoking.
- Treatment with antihypertensive drugs
- Treatment with other hypoglycemic agents that were not metformin
- Treatment with statins, fibrates or other drugs to control dyslipidemia, 6 months before the start of the protocol.
- Any drug or medication that activates intestinal motility
- Use of laxatives or antispasmodics 4 weeks before the study
- Treatment with antibiotics 6 months before the study
- Use of steroids, chemotherapy, immunosuppressant or radiotherapy.
- Uncontrolled type 2 diabetes, ( HbA1c concentration ≥ 9.9%)
- Fasting glucose ≥ 220 mg / dL
- Fasting cholesterol ≥ 240 mg / dL
- Fasting triglycerides ≥ 350 mg / dL
- Serum creatinine in women> 1.2 mg / dL in men> 1.3 mg / d
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Placebo Comparator
Arm Label
1. Dietary portfolio (DP)
2. placebo (P)
Arm Description
the dietary portfolio was given daily in the breakfast and dinner for 2.5 months
the placebo (P) was based was given daily in the breakfast and dinner for 2.5 months
Outcomes
Primary Outcome Measures
intestinal microbiota
Measurement of intestinal microbiota by sequencing using the Illumina platform
Secondary Outcome Measures
Glucose metabolism profile
serum glucose (mg/dl)
Glucose metabolism profile
serum insulin (µUI/ml)
Glucose metabolism profile
plasma glycated hemoglobin (HbA1c) (%)
Lipid metabolism profile
serum triglycerides (mg/dl)
Lipid metabolism profile
serum total cholesterol (mg/dl)
Lipid metabolism profile
serum LDL cholesterol (mg/dl)
Lipid metabolism profile
serum HDL cholesterol (mg/dl)
Lipid metabolism profile
plasma free fatty acids (FFA) (mmol/L)
metabolomic profile
plasma betaine (µmol/L)
metabolomic profile
plasma choline (µmol/L)
metabolomic profile
plasma trimethylamine oxide (TMAO) (µmol/L)
metabolomic profile
plasma branched chain amino acids (BCAA) (µmol/L)
inflammatory profile
plasma lipopolysaccharide (LPS) (ng/ml)
inflammatory profile
serum C reactive protein (CRP) (mg/dl)
Full Information
NCT ID
NCT03421301
First Posted
January 17, 2018
Last Updated
January 29, 2018
Sponsor
Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran
Collaborators
University of Connecticut
1. Study Identification
Unique Protocol Identification Number
NCT03421301
Brief Title
Dietary Intervention Modifies Gut Microbiota in Type 2 Diabetes.
Official Title
A Dietary Intervention With Functional Foods Reduce Metabolic Endotoxemia and Attenuates Biochemical Abnormalities in Subjects With Type 2 Diabetes by Modifying the Gut Microbiota.
Study Type
Interventional
2. Study Status
Record Verification Date
January 2018
Overall Recruitment Status
Completed
Study Start Date
August 7, 2014 (Actual)
Primary Completion Date
September 28, 2016 (Actual)
Study Completion Date
December 28, 2016 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran
Collaborators
University of Connecticut
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Aim: To study the effect of a dietary intervention with functional foods on gut microbiota in subjects with type 2 diabetes Materials and methods: Patients with type 2 diabetes were enrolled in a double-blind, parallel-arm, placebo-control study were randomized to receive a dietary portfolio (DP) or placebo (P) treatment for 3 mo. The primary endpoint was the effect of a dietary portfolio based on functional foods on gut microbiota. Secondary endpoints were biochemical parameters, branched chain amino acids, TMAO
Detailed Description
This study was a single-center, randomized, controlled, double-blind, parallel versus placebo that consisted of six visits. The first visit was a screening evaluation to determine whether subjects meet the inclusion criteria. The selected subjects were invited to a second visit that consisted of a medical history, 2-h oral glucose tolerance test (OGTT), collection of stool samples for DNA isolation and collection of 5 ml blood sample. The participants received the first stage dietary strategy for 15 days. In the third visit and second stage of dietary treatment, subjects were randomized to received the dietary portfolio (DP) or placebo (P) treatment accompanied of the reduced energy diet for 1 mo. In the fourth and fifth visits, with a 1 mo interval, dietary assessment and compliance to the DP or P was evaluated. During each follow-up visit, a 24-h dietary recall was collected, a physical activity questionnaire was filled out and anthropometric and clinical parameters were assessed. In the sixth visit, a 2-h oral glucose tolerance test (OGTT) was performed, and a stool sample for DNA isolation and 5 ml blood were collected.
Dietary Intervention In the first stage, the participants consumed a reduced-energy diet tailored to provide a 500-kcal/d deficit as recommended by NIH (8) the with respect to their habitual diet for 15 days. The diet plan consisted in 45-55% carbohydrates, 15-20% protein, 25-35% fat, <7% saturated fat, 200 mg/d cholesterol, 20-35g fiber, 2000-3000 mg/d sodium based on total energy. In the second stage the participants continued to consume the reduced energy diet with the addition of a combination of functional foods (dietary portfolio; DP). The DP provided 200 kcal that were subtracted from the diet. The DP consisted of a mixture of 14g of dehydrated nopal, 4g of chia seed, 30g of soy protein, 4g of inulin,) and 1g of flavoring. The placebo (P) consisted of 28 g of calcium caseinate, 15g of maltodextrin and 1g of flavoring. The kcal, appearance and flavor were similar in DP and P. The DP and P was given in a package in dehydrated form ready to be dissolved in water. The DP was divided into two packages, the first package contained 17.3 g of DP or P given in the breakfast and dissolved in 250 ml and the second package was given at the dinner time (15:00-16:00 h) and contained 34.7g of P and DP dissolved in 300 mL of water.
Dietary compliance Dietary compliance was assessed with a 24-h dietary recall and 3-d food record (food log), during each visit that were analyzed by Food Processor Nutrition Analysis Software. The compliance of the consumption of the DP or P was evaluated with the number of empty packages returned at the following visit. Physical activity was assessed using the International physical activity questionnaire (IPAQ).
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 2 Diabetes Mellitus
Keywords
gut microbiota, functional foods, branched chain amino acids, TMAO, type 2 diabetes
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
In the first stage, the participants with type 2 diabetes consumed a reduced-energy diet tailored to provide a 500-kcal/d deficit as recommended by NIH (8) the with respect to their habitual diet for 15 days. In the second stage the participants continued to consume the reduced energy diet with the addition of a combination of functional foods (dietary portfolio; DP). The DP provided 200 kcal that were subtracted from the diet. The DP consisted of a mi The kcal, appearance and flavor were similar in DP and P. The DP and P was given in a package in dehydrated form ready to be dissolved in water. The DP was divided into two packages, the first package contained 17.3 g of DP or P given in the breakfast and dissolved in 250 ml and the second package was given at the dinner time (15:00-16:00 h) and contained 34.7g of P and DP dissolved in 300 mL of water.
Masking
ParticipantInvestigator
Masking Description
PD and placebo interventions were packaged identically in appearance, both the researcher and the participant did not know what type of maneuver was assigned. The envelopes were distributed by a person outside the study who was the same who performed the randomization.
Study staff and participants were blinded during the assignment and execution of interventions in the study. The packages given to the participants were 2 per day, the placebo packages were matched in grams, calories, color, appearance, flavor to the PD.
Allocation
Randomized
Enrollment
81 (Actual)
8. Arms, Groups, and Interventions
Arm Title
1. Dietary portfolio (DP)
Arm Type
Experimental
Arm Description
the dietary portfolio was given daily in the breakfast and dinner for 2.5 months
Arm Title
2. placebo (P)
Arm Type
Placebo Comparator
Arm Description
the placebo (P) was based was given daily in the breakfast and dinner for 2.5 months
Intervention Type
Dietary Supplement
Intervention Name(s)
dietary portfolio
Intervention Description
The dietary intervention was a combination of functional foods (dehydrated nopal, chia seed, soy protein and inulin) that was provided in dehydrated form in packages of 17.3 g dissolved in 250 ml water for breakfast and 34.7 g in 300 ml water for dinner.
Primary Outcome Measure Information:
Title
intestinal microbiota
Description
Measurement of intestinal microbiota by sequencing using the Illumina platform
Time Frame
Change from baseline gut microbiota at three months after the dietary intervention
Secondary Outcome Measure Information:
Title
Glucose metabolism profile
Description
serum glucose (mg/dl)
Time Frame
Change from baseline serum glucose at three months after dietary intervention
Title
Glucose metabolism profile
Description
serum insulin (µUI/ml)
Time Frame
Change from baseline serum insulin at three months after dietary intervention
Title
Glucose metabolism profile
Description
plasma glycated hemoglobin (HbA1c) (%)
Time Frame
Change from baseline plasma HbA1c at three months after dietary intervention
Title
Lipid metabolism profile
Description
serum triglycerides (mg/dl)
Time Frame
Change from baseline serum triglycerides at three months after dietary intervention
Title
Lipid metabolism profile
Description
serum total cholesterol (mg/dl)
Time Frame
Change from baseline serum total cholesterol at three months after dietary intervention
Title
Lipid metabolism profile
Description
serum LDL cholesterol (mg/dl)
Time Frame
Change from baseline serum LDL cholesterol at three months after dietary intervention
Title
Lipid metabolism profile
Description
serum HDL cholesterol (mg/dl)
Time Frame
Change from baseline serum HDL cholesterol at three months after dietary intervention
Title
Lipid metabolism profile
Description
plasma free fatty acids (FFA) (mmol/L)
Time Frame
Change from baseline plasma free fatty acids at three months after dietary intervention
Title
metabolomic profile
Description
plasma betaine (µmol/L)
Time Frame
Change from baseline plasma betaine at three months after dietary intervention
Title
metabolomic profile
Description
plasma choline (µmol/L)
Time Frame
Change from baseline plasma choline at three months after dietary intervention
Title
metabolomic profile
Description
plasma trimethylamine oxide (TMAO) (µmol/L)
Time Frame
Change from baseline plasma TMAO at three months after dietary intervention
Title
metabolomic profile
Description
plasma branched chain amino acids (BCAA) (µmol/L)
Time Frame
Change from baseline plasma BCAA at three months after dietary intervention
Title
inflammatory profile
Description
plasma lipopolysaccharide (LPS) (ng/ml)
Time Frame
Change from baseline plasma LPS at three months after dietary intervention
Title
inflammatory profile
Description
serum C reactive protein (CRP) (mg/dl)
Time Frame
Change from baseline serum CRP at three months after dietary intervention
10. Eligibility
Sex
All
Minimum Age & Unit of Time
30 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
clinical diagnosis of type 2 diabetes
Male or female.
Adults between 30 and 60 years old.
BMI of 25 to 39.9 kg / m².
Pharmacological treatment with metformin, a combination of metformin and glibenclamide.
Evolution of the type 2 diabetes of 4 ± 3 years.
Patients who knew how to read and write.
Signature of informed consent.
Exclusion Criteria:
Diseases that produce secondary obesity.
Cardiovascular event.
Weight loss> 3 kg in the last 3 months after the evaluation of the criteria.
Catabolic diseases such as cancer and acquired immunodeficiency syndrome.
Gravidity status.
Positive smoking.
Treatment with antihypertensive drugs
Treatment with other hypoglycemic agents that were not metformin
Treatment with statins, fibrates or other drugs to control dyslipidemia, 6 months before the start of the protocol.
Any drug or medication that activates intestinal motility
Use of laxatives or antispasmodics 4 weeks before the study
Treatment with antibiotics 6 months before the study
Use of steroids, chemotherapy, immunosuppressant or radiotherapy.
Uncontrolled type 2 diabetes, ( HbA1c concentration ≥ 9.9%)
Fasting glucose ≥ 220 mg / dL
Fasting cholesterol ≥ 240 mg / dL
Fasting triglycerides ≥ 350 mg / dL
Serum creatinine in women> 1.2 mg / dL in men> 1.3 mg / d
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nimbe Torres, PhD
Organizational Affiliation
Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran
Official's Role
Principal Investigator
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
15111519
Citation
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004 May;27(5):1047-53. doi: 10.2337/diacare.27.5.1047.
Results Reference
result
PubMed Identifier
24026559
Citation
Mahendran Y, Cederberg H, Vangipurapu J, Kangas AJ, Soininen P, Kuusisto J, Uusitupa M, Ala-Korpela M, Laakso M. Glycerol and fatty acids in serum predict the development of hyperglycemia and type 2 diabetes in Finnish men. Diabetes Care. 2013 Nov;36(11):3732-8. doi: 10.2337/dc13-0800. Epub 2013 Sep 11.
Results Reference
result
PubMed Identifier
12502486
Citation
Evans JL, Goldfine ID, Maddux BA, Grodsky GM. Are oxidative stress-activated signaling pathways mediators of insulin resistance and beta-cell dysfunction? Diabetes. 2003 Jan;52(1):1-8. doi: 10.2337/diabetes.52.1.1.
Results Reference
result
PubMed Identifier
23563705
Citation
Koeth RA, Wang Z, Levison BS, Buffa JA, Org E, Sheehy BT, Britt EB, Fu X, Wu Y, Li L, Smith JD, DiDonato JA, Chen J, Li H, Wu GD, Lewis JD, Warrier M, Brown JM, Krauss RM, Tang WH, Bushman FD, Lusis AJ, Hazen SL. Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat Med. 2013 May;19(5):576-85. doi: 10.1038/nm.3145. Epub 2013 Apr 7.
Results Reference
result
PubMed Identifier
25691688
Citation
Griffin JL, Wang X, Stanley E. Does our gut microbiome predict cardiovascular risk? A review of the evidence from metabolomics. Circ Cardiovasc Genet. 2015 Feb;8(1):187-91. doi: 10.1161/CIRCGENETICS.114.000219.
Results Reference
result
PubMed Identifier
27409811
Citation
Pedersen HK, Gudmundsdottir V, Nielsen HB, Hyotylainen T, Nielsen T, Jensen BA, Forslund K, Hildebrand F, Prifti E, Falony G, Le Chatelier E, Levenez F, Dore J, Mattila I, Plichta DR, Poho P, Hellgren LI, Arumugam M, Sunagawa S, Vieira-Silva S, Jorgensen T, Holm JB, Trost K; MetaHIT Consortium; Kristiansen K, Brix S, Raes J, Wang J, Hansen T, Bork P, Brunak S, Oresic M, Ehrlich SD, Pedersen O. Human gut microbes impact host serum metabolome and insulin sensitivity. Nature. 2016 Jul 21;535(7612):376-81. doi: 10.1038/nature18646. Epub 2016 Jul 13.
Results Reference
result
PubMed Identifier
25260659
Citation
Serralde-Zuniga AE, Guevara-Cruz M, Tovar AR, Herrera-Hernandez MF, Noriega LG, Granados O, Torres N. Omental adipose tissue gene expression, gene variants, branched-chain amino acids, and their relationship with metabolic syndrome and insulin resistance in humans. Genes Nutr. 2014 Nov;9(6):431. doi: 10.1007/s12263-014-0431-5. Epub 2014 Sep 27.
Results Reference
result
PubMed Identifier
9813653
Citation
Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. Obes Res. 1998 Sep;6 Suppl 2:51S-209S. No abstract available. Erratum In: Obes Res 1998 Nov;6(6):464.
Results Reference
result
PubMed Identifier
28680065
Citation
Sanchez-Tapia M, Aguilar-Lopez M, Perez-Cruz C, Pichardo-Ontiveros E, Wang M, Donovan SM, Tovar AR, Torres N. Nopal (Opuntia ficus indica) protects from metabolic endotoxemia by modifying gut microbiota in obese rats fed high fat/sucrose diet. Sci Rep. 2017 Jul 5;7(1):4716. doi: 10.1038/s41598-017-05096-4.
Results Reference
result
PubMed Identifier
21702898
Citation
Segata N, Izard J, Waldron L, Gevers D, Miropolsky L, Garrett WS, Huttenhower C. Metagenomic biomarker discovery and explanation. Genome Biol. 2011 Jun 24;12(6):R60. doi: 10.1186/gb-2011-12-6-r60.
Results Reference
result
PubMed Identifier
26633628
Citation
Forslund K, Hildebrand F, Nielsen T, Falony G, Le Chatelier E, Sunagawa S, Prifti E, Vieira-Silva S, Gudmundsdottir V, Pedersen HK, Arumugam M, Kristiansen K, Voigt AY, Vestergaard H, Hercog R, Costea PI, Kultima JR, Li J, Jorgensen T, Levenez F, Dore J; MetaHIT consortium; Nielsen HB, Brunak S, Raes J, Hansen T, Wang J, Ehrlich SD, Bork P, Pedersen O. Disentangling type 2 diabetes and metformin treatment signatures in the human gut microbiota. Nature. 2015 Dec 10;528(7581):262-266. doi: 10.1038/nature15766. Epub 2015 Dec 2. Erratum In: Nature. 2017 May 3;545(7652):116.
Results Reference
result
PubMed Identifier
8098788
Citation
van der Hulst RR, van Kreel BK, von Meyenfeldt MF, Brummer RJ, Arends JW, Deutz NE, Soeters PB. Glutamine and the preservation of gut integrity. Lancet. 1993 May 29;341(8857):1363-5. doi: 10.1016/0140-6736(93)90939-e.
Results Reference
result
PubMed Identifier
27749689
Citation
Achamrah N, Dechelotte P, Coeffier M. Glutamine and the regulation of intestinal permeability: from bench to bedside. Curr Opin Clin Nutr Metab Care. 2017 Jan;20(1):86-91. doi: 10.1097/MCO.0000000000000339.
Results Reference
result
PubMed Identifier
22517736
Citation
Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR; American Diabetes Association (ADA); European Association for the Study of Diabetes (EASD). Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012 Jun;35(6):1364-79. doi: 10.2337/dc12-0413. Epub 2012 Apr 19. No abstract available. Erratum In: Diabetes Care. 2013 Feb;36(2):490.
Results Reference
result
PubMed Identifier
24939063
Citation
Gomes AC, Bueno AA, de Souza RG, Mota JF. Gut microbiota, probiotics and diabetes. Nutr J. 2014 Jun 17;13:60. doi: 10.1186/1475-2891-13-60.
Results Reference
result
PubMed Identifier
17934076
Citation
Wexler HM. Bacteroides: the good, the bad, and the nitty-gritty. Clin Microbiol Rev. 2007 Oct;20(4):593-621. doi: 10.1128/CMR.00008-07.
Results Reference
result
PubMed Identifier
22079683
Citation
Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011 Dec;94(3):311-21. doi: 10.1016/j.diabres.2011.10.029. Epub 2011 Nov 12.
Results Reference
result
PubMed Identifier
23092914
Citation
Timper K, Grisouard J, Sauter NS, Herzog-Radimerski T, Dembinski K, Peterli R, Frey DM, Zulewski H, Keller U, Muller B, Christ-Crain M. Glucose-dependent insulinotropic polypeptide induces cytokine expression, lipolysis, and insulin resistance in human adipocytes. Am J Physiol Endocrinol Metab. 2013 Jan 1;304(1):E1-13. doi: 10.1152/ajpendo.00100.2012. Epub 2012 Oct 23.
Results Reference
result
PubMed Identifier
12028371
Citation
Boden G, Shulman GI. Free fatty acids in obesity and type 2 diabetes: defining their role in the development of insulin resistance and beta-cell dysfunction. Eur J Clin Invest. 2002 Jun;32 Suppl 3:14-23. doi: 10.1046/j.1365-2362.32.s3.3.x.
Results Reference
result
PubMed Identifier
17533210
Citation
Wilson PW, Meigs JB, Sullivan L, Fox CS, Nathan DM, D'Agostino RB Sr. Prediction of incident diabetes mellitus in middle-aged adults: the Framingham Offspring Study. Arch Intern Med. 2007 May 28;167(10):1068-74. doi: 10.1001/archinte.167.10.1068.
Results Reference
result
PubMed Identifier
28183445
Citation
Gomes JMG, Costa JA, Alfenas RCG. Metabolic endotoxemia and diabetes mellitus: A systematic review. Metabolism. 2017 Mar;68:133-144. doi: 10.1016/j.metabol.2016.12.009. Epub 2016 Dec 18.
Results Reference
result
PubMed Identifier
28966614
Citation
Leite AZ, Rodrigues NC, Gonzaga MI, Paiolo JCC, de Souza CA, Stefanutto NAV, Omori WP, Pinheiro DG, Brisotti JL, Matheucci Junior E, Mariano VS, de Oliveira GLV. Detection of Increased Plasma Interleukin-6 Levels and Prevalence of Prevotella copri and Bacteroides vulgatus in the Feces of Type 2 Diabetes Patients. Front Immunol. 2017 Sep 15;8:1107. doi: 10.3389/fimmu.2017.01107. eCollection 2017.
Results Reference
result
PubMed Identifier
23023125
Citation
Qin J, Li Y, Cai Z, Li S, Zhu J, Zhang F, Liang S, Zhang W, Guan Y, Shen D, Peng Y, Zhang D, Jie Z, Wu W, Qin Y, Xue W, Li J, Han L, Lu D, Wu P, Dai Y, Sun X, Li Z, Tang A, Zhong S, Li X, Chen W, Xu R, Wang M, Feng Q, Gong M, Yu J, Zhang Y, Zhang M, Hansen T, Sanchez G, Raes J, Falony G, Okuda S, Almeida M, LeChatelier E, Renault P, Pons N, Batto JM, Zhang Z, Chen H, Yang R, Zheng W, Li S, Yang H, Wang J, Ehrlich SD, Nielsen R, Pedersen O, Kristiansen K, Wang J. A metagenome-wide association study of gut microbiota in type 2 diabetes. Nature. 2012 Oct 4;490(7418):55-60. doi: 10.1038/nature11450. Epub 2012 Sep 26.
Results Reference
result
PubMed Identifier
27899875
Citation
Jardine M. Nutrition Considerations for Microbiota Health in Diabetes. Diabetes Spectr. 2016 Nov;29(4):238-244. doi: 10.2337/ds16-0003. No abstract available.
Results Reference
result
PubMed Identifier
25132122
Citation
Lopez-Romero P, Pichardo-Ontiveros E, Avila-Nava A, Vazquez-Manjarrez N, Tovar AR, Pedraza-Chaverri J, Torres N. The effect of nopal (Opuntia ficus indica) on postprandial blood glucose, incretins, and antioxidant activity in Mexican patients with type 2 diabetes after consumption of two different composition breakfasts. J Acad Nutr Diet. 2014 Nov;114(11):1811-8. doi: 10.1016/j.jand.2014.06.352. Epub 2014 Aug 12.
Results Reference
result
Learn more about this trial
Dietary Intervention Modifies Gut Microbiota in Type 2 Diabetes.
We'll reach out to this number within 24 hrs