Natural Chu

Metformin efficiently lowers blood glucose levels but leads to gastrointestinal side effects. However, whether dietary interventions can improve metformin tolerability and glucose-lowering efficacy remains unknown. Here we investigate the effects of pretreatment with a diet rich in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) in combination with metformin on postprandial glycaemia and gut microbiota in people with prediabetes. In a double-blind, randomised, crossover trial, 26 individuals with prediabetes received an isocaloric diet with moderate or low FODMAPs for 10 d, concomitantly with metformin for 5 d, separated by a washout period of 2 weeks. The primary endpoint is the difference in postprandial glycaemia assessed by total postprandial incremental area under the curve through continuous glucose monitoring. Secondary endpoints are differences in glucose, insulin and glucagon-like peptide 1 (GLP-1) levels after an oral glucose tolerance test, gut microbiota, gastrointestinal symptoms and body weight. We show that moderate FODMAPs with metformin, as compared with low FODMAPs with metformin, result in lower postprandial glycaemia, higher GLP-1 secretion and higher Butyricimonas virosa abundance. We also show that a higher baseline abundance of Dorea formicigenerans predicts gastrointestinal intolerance to metformin. These findings have implications for personalizing nutritional and pharmacological interventions to prevent diabetes. ClinicalTrials.gov registration: NCT05628584.

Purpose of review: This review aims to investigate the relationship between dietary changes and the microbiome in patients with diabetes and colorectal cancer (CRC). The link between CRC and type 2 diabetes is momentous, as individuals with diabetes have a 40–60% higher risk of developing CRC and often experience lower survival rates. However, limited studies explore how diabetes may contribute to the progression to CRC through changes in the microbiome. By clarifying these connections, this review summarizes mechanisms in type 2 diabetes and CRC through microbiota pathways, presenting evidence from clinical trials regarding nutritional interventions for treating both conditions. We will focus on how nutritional components can alter the gut microbiome, highlighting the potential role of nutritional adjustments as adjuvant therapy for patients with diabetes who are facing precancerous or cancerous conditions. Recent Findings: There is growing evidence about the interactions between the microbiome and the causes of diabetes and CRC. Both conditions are characterised by changes in the gut microbiome, known as dysbiosis, which involves alterations in specific bacteria, such as Bifidobacterium, Bacteroides, Akkermansia, Faecalibacterium, Ruminococcus, and Fusobacterium. It is important to consider dietary modifications to address dysbiosis, malnutrition, glycemic variability, and inflammation underlying these conditions. Summary: Consuming a higher amount of fermentable carbohydrates alongside a lower amount of fermentable proteins can positively influence the microenvironment that regulates insulin secretion and bile acids, as well as an increase in short-chain fatty acids. This may be beneficial for patients with diabetes and CRC. However, it is also important to consider potential interactions between food and medication as well as gastrointestinal tolerability.

Controlling the epidemic of diabetes is an urgent global healthcare challenge. The low uptake of diabetes prevention programs highlights difficulties in scalability, partly due to the need for intensive face‐to‐face contact and its impact on healthcare resource utilization. In this narrative review, we will summarize the latest evidence in technology‐assisted lifestyle interventions. We will appraise evidence of digital diabetes prevention programs that use internet platforms or text messaging tools to support information delivery, lifestyle coaching, or peer support. We will also discuss the use of wearables, including physical activity trackers and continuous glucose monitoring (CGM) as part of lifestyle intervention. Experience from diabetes highlights the potential for CGM as a motivational tool to promote lifestyle change. The integration of digital data may facilitate earlier detection of prediabetes, sub‐phenotyping, and personalized nutritional predictions. We will highlight major gaps in research and the need for rigorous clinical trials to evaluate the acceptability and cost‐effectiveness of integrating technologies as part of a multicomponent strategy in diabetes prevention.

Background/Objectives: Dietary manipulation with carbohydrate restriction has been extensively investigated in diabetes prevention programmes. Carbohydrate (CHO) quality, rather than quantity, is associated with various metabolic outcomes. Few studies examined the fibre/CHO ratio on lipid profiles, liver fat and insulin resistance in individuals with impaired glucose tolerance (IGT). Methods: In this comprehensive cross-sectional study, we evaluated the association of carbohydrate-related nutritional factors with metabolic parameters in a cohort of 177 Hong Kong Chinese with impaired glucose tolerance (IGT). The subjects underwent a 75 g oral glucose tolerance test (OGTT) with measurement of plasma C-peptide and lipid profiles, body composition, transient elastography, and three-day food records. The fibre/CHO ratio is calculated by dividing fibre intake by total carbohydrate intake (in grams). Results: The median (IQR) age of the study cohort was 60 (54–62) with a mean ± SD BMI of 26.7 ± 3.9 kg/m², and 40.7% were female. A higher carbohydrate quality, measured as fibre/CHO ratio, was inversely correlated with triglycerides (r = −0.305, p < 0.001) and positively correlated with High-density lipoproteins cholesterol (HDL-C) (r = 0.354, p < 0.001). These associations remained significant after adjusting for age, gender, lipid-lowering drugs, total calorie, macronutrient and sugar intake, physical activity and sodium/potassium ratio. Blood pressure, liver fat and insulin resistance were also associated with the fibre/CHO ratio after the adjustment of these confounding factors. Consuming more than 5.5 g of fibre per 100 g carbohydrate was associated with lower serum triglycerides. Conclusions: Our results highlight the potential for using the fibre/CHO ratio as a metric for daily carbohydrate quality and the importance of addressing both carbohydrate quality and quantity in designing dietary interventions to reduce cardiometabolic risk.

Evidence‐based guidelines provide the premise for the delivery of quality care to preserve health and prevent disabilities and premature death. The systematic gathering of observational, mechanistic and experimental data contributes to the hierarchy of evidence used to guide clinical practice. In the field of diabetes, metformin was discovered more than 100 years ago, and with 60 years of clinical use, it has stood the test of time regarding its value in the prevention and management of type 2 diabetes. Although some guidelines have challenged the role of metformin as the first‐line glucose‐lowering drug, it is important to point out that the cardiovascular‐renal protective effects of sodium‐glucose co‐transporter‐2 inhibitors and glucagon‐like peptide‐1 receptor agonists were gathered from patients with type 2 diabetes, the majority of whom were treated with metformin. Most national, regional and international guidelines recommend metformin as a foundation therapy with emphasis on avoidance of therapeutic inertia and early attainment of multiple treatment goals. Moreover, real‐world evidence has confirmed the glucose‐lowering and cardiovascular‐renal benefits of metformin accompanied by an extremely low risk of lactic acidosis. In patients with type 2 diabetes and advanced chronic kidney disease (estimated glomerular filtration rate 15‐30 mL/min/1.73m ² ), metformin discontinuation was associated with an increased risk of cardiovascular‐renal events compared with metformin persistence. Meanwhile, it is understood that microbiota, nutrients and metformin can interact through the gut‐brain‐kidney axis to modulate homeostasis of bioactive molecules, systemic inflammation and energy metabolism. While these biological changes contribute to the multisystem effects of metformin, they may also explain the gastrointestinal side effects and vitamin B12 deficiency associated with metformin intolerance. By understanding the interactions between metformin, foods and microbiota, healthcare professionals are in a better position to optimize the use of metformin and mitigate potential side effects. The United Kingdom Prospective Diabetes Study and the Da Qing Diabetes Prevention Program commenced 40 years ago provided the first evidence that type 2 diabetes is preventable and treatable. To drive real‐world impact from this evidence, payors, practitioners and planners need to co‐design and implement an integrated, data‐driven, metformin‐based programme to detect people with undiagnosed diabetes and prediabetes (intermediate hyperglycaemia), notably impaired glucose tolerance, for early intervention. The systematic data collection will create real‐world evidence to bring out the best of metformin and make healthcare sustainable, affordable and accessible.

Exploring the intricate crosstalk between dietary prebiotics and the specific intestinal microbiome (SIM) is intriguing in explaining the mechanisms of current successful dietary interventions, including the Mediterranean diet and high-fiber diet. This knowledge forms a robust basis for developing a new natural food therapy. The SIM diet can be measured and evaluated to establish a reliable basis for the management of metabolic diseases, such as diabetes, metabolic (dysfunction)-associated fatty liver disease (MAFLD), obesity, and metabolic cardiovascular disease. This review aims to delve into the existing body of research to shed light on the promising developments of possible dietary prebiotics in this field and explore the implications for clinical practice. The exciting part is the crosstalk of diet, microbiota, and gut–organ interactions facilitated by producing short-chain fatty acids, bile acids, and subsequent metabolite production. These metabolic-related microorganisms include Butyricicoccus, Akkermansia, and Phascolarctobacterium. The SIM diet, rather than supplementation, holds the promise of significant health consequences via the prolonged reaction with the gut microbiome. Most importantly, the literature consistently reports no adverse effects, providing a strong foundation for the safety of this dietary therapy.

Introduction: Type 2 diabetes is preventable in subjects with impaired glucose tolerance based on 2-hour plasma glucose (2hPG) during 75 g oral glucose tolerance test (OGTT). We incorporated routine biochemistry to improve the performance of a non-invasive diabetes risk score to identify individuals with abnormal glucose tolerance (AGT) defined by 2hPG≥7.8 mmol/L during OGTT. Research design and methods: We used baseline data of 1938 individuals from the community-based “Better Health for Better Hong Kong - Hong Kong Family Diabetes Study (BHBHK-HKFDS) Cohort” recruited in 1998–2003. We incorporated routine biochemistry in a validated non-invasive diabetes risk score, and evaluated its performance using area under receiver operating characteristics (AUROC) with internal and external validation. Results: The AUROC of the original non-invasive risk score to predict AGT was 0.698 (95% CI, 0.662 to 0.733). Following additional inclusion of fasting plasma glucose, serum potassium, creatinine, and urea, the AUROC increased to 0.778 (95% CI, 0.744 to 0.809, p2=11.315, p=0.1845) and performance on external validation using an independent data set (AUROC=0.722, 95% CI, 0.680 to 0.764). Conclusions: The extended risk score incorporating clinical and routine biochemistry can be integrated into an electronic health records system to select high-risk subjects for evaluation of AGT using OGTT for prevention of diabetes.