Grant: Project Grant

BACKGROUND Despite the many gains made in clinical medicine and public health, we are confronted with a rapidly growing pandemic of noncommunicable diseases fuelled by obesity and diabetes. The antidiabetic medication, acarbose, is an oral medication consumed with a meal which slows and decreases the absorption of carbohydrates and prevents diabetes in high-risk individuals. Viscous dietary fibres have also been shown to slow and decrease carbohydrate absorption and improve blood sugar control. Could studying the two interventions simultaneously provide insights into the role of viscous dietary fibre for diabetes prevention? OBJECTIVES 1. To assess the effect of an acarbose equivalent dose of viscous dietary fibre (using psyllium as the prototypical viscous fibre) on carbohydrate metabolism as measured by blood sugar control and insulin sensitivity in high-risk individuals for developing type 2 diabetes. 2. To assess genetic, blood and gut bacteria profiles for drivers and barriers of adherence and response. RESEARCH APPROACH We will first conduct an acute feeding, crossover, randomized controlled trial to identify a psyllium dose equivalent to acarbose on reducing the post-meal blood sugar response in high-risk individuals with overweight/obesity and impaired blood sugar control. We will then conduct a double-blind, parallel, randomized controlled trial to determine the effect of psyllium (provided at the dose level determined to be equivalent to acarbose) on carbohydrate metabolism in a larger sample of the same high-risk population. Metabolomic and microbiomic variation will be used to understand drivers and barriers of adherence and response. IMPORTANCE By using acarbose to understand the impact of an existing nutritional intervention (viscous fibre), we will provide the basis for the development and testing (large clinical outcomes trials) of novel interventions for the prevention of diabetes.