Garvan Breakthrough magazine - Aug 2018

Prediabetes can fly under the radar for years – until the symptoms crash down like Jenga blocks.

Diabetes researchers also saw another signpost pointing towards the microbiome as a key contributor to response to diabetes therapy – a 60-year-old medication called metformin. It is a commonly prescribed drug for type 2 diabetes. “We know that this drug makes people more sensitive to insulin – it fights insulin resistance – but we’re still figuring out the exact mechanism. From large clinical studies, we know that 20 to 40% of individuals with prediabetes or type 2 diabetes have a poor response to metformin. But it’s emerging that metformin affects the gut microorganisms in a positive way,” says Dorit. Know your microbiome This led Dorit to want to find out more about the relationship between gut microorganisms and the way we respond to metformin. She has surmised, and will study in the PREDICT clinical trial, that the genetic makeup of the billions of microorganisms in your gut could be the differentiator in how well your body processes sugar after meals and how you respond to common treatments like weight loss and metformin. “At the moment, our standard of care for a person with prediabetes is to advise a low fat, low sugar diet and try to be more active, to lose weight. But we’re looking for more precise ways to treat people.” Going forward, Garvan’s aim is to translate findings from the PREDICT study to provide tools for clinicians to guide patients on medication, diet and lifestyle choices. This will hopefully help clinicians and their patients stop prediabetes from progressing to full-blown type 2 diabetes and to assist those living with diabetes to gain more tools to manage their health and achieve better quality of life.

The PREDICT Clinical Trial

During the six-month study, participants will wear a continuous glucose monitor for two weeks before and during treatment.

Participants will document all food intake in a specialised mobile phone app.

The PREDICT clinical trial is currently taking enrolments of men and women aged 20-70 years who have prediabetes (e.g. you have been told you are at risk of developing type 2 diabetes or you have had increased blood sugar in previous blood tests) or recently diagnosed type 2 diabetes, not yet treated with a sugar- lowering medication. Study visits are conducted at the Garvan Institute of Medical Research and St Vincent’s Hospital, Darlinghurst, Sydney.

Principal Investigators: Professor Jerry Greenfield and Dr Dorit Samocha-Bonet

Phone: (02) 9295 8215 Email: PREDICT@garvan.org.au.

ClinicalTrials.gov ID: NCT03558867 St Vincent’s HREC Ref: 17/SVH/080

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