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The primary objective of this clinical-trial is to determine, in subjects with impaired fasting glucose (IFG) and/or insulin resistance (IR), if tagatose meets the definition of a prebiotic, namely that consuming tagatose for 4 weeks selectively stimulates the selective growth of bacteria in the colon and is associated with a health benefit (oral glucose tolerance) when compared to consuming the control treatment (10g sucrose) for 4 weeks.
Available evidence suggests that tagatose may act as a prebiotic compound. It has been hypothesized that undigested tagatose reaches the colon and is fermented by colonic bacteria, resulting in the production of short-chain fatty acids (SCFA) which stimulate GLP-1 secretion from colonic L-cells, which, in turn, improves glycemic control by increasing insulin sensitivity and insulin secretion. However, the fermentation of tagatose and subsequent effects have only been demonstrated in preclinical models, with limited clinical trials examining the effect of tagatose on glycemic control. Given the dearth of clinical evidence in humans supporting the ability of tagatose to be fermented in the colon and to improve glycemic control, the present study aims to explore if tagatose is selectively utilized by human gut microorganisms conferring a beneficial effect on glycemic control.
Thus, the investigators aim to recruit 55 healthy adults with impaired fasting glucose and/or hyperinsulinemia into a double-blind, randomized, controlled, clinical trial with a cross-over design.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Tagatose | Experimental | 10 grams tagatose |
|
| Placebo | Placebo Comparator | 10 grams sucrose |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Tagatose | Other | Sachet containing 10g tagatose to be dissolved in 250ml water and taken once daily on Days 1-28 of a 4-week dosing period. (1 of 2 dosing periods separated by a 4-week washout) |
| Measure | Description | Time Frame |
|---|---|---|
| Change in incremental area under the plasma glucose curve (ignoring area below the baseline, iAUC) over each 4-week intervention period | Finger stick blood samples obtained fasted prior to consuming 50 grams of glucose. Six additional finger stick blood samples obtained over the next 2 hours beginning 15 minutes after consumption. | Before (-5 minutes and 0 minutes) and 15, 30, 45, 60, 90 and 120 minutes after overnight fasted subjects start to consume 50 grams of glucose on Day 1 and Day 29 of each of two 4-week intervention periods |
| Measure | Description | Time Frame |
|---|---|---|
| Fecal microbiota composition | Stool sample measured via 16S rRNA sequencing | Pre-dose baseline and Week 4 for each of two 4-week dosing periods |
| Measure | Description | Time Frame |
|---|---|---|
| Fasting serum short-chain fatty acid (SCFA) | Serum from venous blood sample | Pre-dose baseline Day 1 and Day 29 of each of two 4-week dosing periods |
| Fasting serum bile acids (BA) | Serum from venous blood sample |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Thomas MS Wolever, MD, PhD | INQUIS Clinical Research | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| INQUIS Clinical Research | Toronto | Ontario | M5C 2N8 | Canada |
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| ID | Term |
|---|---|
| D018149 | Glucose Intolerance |
| D003141 | Communicable Diseases |
| D007333 | Insulin Resistance |
| ID | Term |
|---|---|
| D006943 | Hyperglycemia |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
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| ID | Term |
|---|---|
| C030192 | tagatose |
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| Placebo | Other | Sachet containing 10g sucrose to be dissolved in 250ml water and taken once daily on Days 1-28 of a 4-week dosing period. (1 of 2 dosing periods separated by a 4-week washout) |
|
| Pre-dose baseline Day 1 and Day 29 of each of two 4-week dosing periods |
| Serum glucose total AUC 0-2 hours, peak concentrations and peak rises for glucose; glucose concentrations and increments at each time point over 2 hours | Finger stick blood samples in unit mmol/L | Fasted at -5 minutes Time 0 pre-dose, post-dose 15, 30, 45, 60, 90 and 120 minutes post-dose. |
| Serum insulin iAUC 0-2 hours; total AUC 0-2 hours, peak concentrations and peak rises for insulin; insulin concentrations and increments at each time point over 2h | Finger stick blood samples in unit mU/L | Fasted at -5 minutes, Time 0 pre-dose, post-dose 15, 30, 45, 60, 90 and 120 minutes post-dose. |
| Indices of insulin resistance | Calculated from fasting plasma glucose (FPG) and fasting serum insulin (FSI) (HOMA-IR) (no units) = FPG(mmol/L) x FSI(mU/L)/22.5 | Pre-dose baseline Day 1 and Day 29 of each of two 4-week dosing periods |
| Indices of insulin secretion | Calculated from fasting plasma glucose and fasting serum insulin (HOMA-B ) (no units) = 20 x FSI(mU/L)/(FPG(mmol/L) - 3.5) | Pre-dose baseline Day 1 and Day 29 of each of two 4-week dosing periods |
| Matsuda's index of insulin sensitivity | Derived from the plasma glucose and serum insulin concentrations measured during the oral glucose tolerance test (OGTT) (no units) | Pre-dose baseline Day 1 and Day 29 of each of two 4-week dosing periods |
| Abdul-Ghani et al. indices of liver insulin sensitivity | Total areas under the curve (no units), calculated as (gAUC0-30) x (iAUC0-30 | Pre-dose baseline Day 1 and Day 29 of each of two 4-week dosing periods, from 0-30 minutes after the oral glucose load for plasma glucose and serum insulin |
| Abdul-Ghani et al. indices of muscle insulin sensitivity | Calculated as (dG/dt)/INS (no units) | Pre-dose baseline Day 1 and Day 29 of each of two 4-week dosing periods, from 0-120 minutes |
| Intake of dietary fiber and selected macro- and micro-nutrients | Assessed using 3-day diet records | Recorded consumption for 2 weekdays and 1 weekend day during the week before the visit at the end of each 28 day dosing period |
| Optional Outcome: Glucagon-like peptide-1 (GLP-1) concentrations pending significant changes in butyrate concentrations | Serum from venous blood sample | Pre-dose baseline Day 1 and Day 29 of each of two 4-week dosing periods |
| D007239 | Infections |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D006946 | Hyperinsulinism |