Study timeline and protocol
The study timeline and protocol are presented in Phase 1 consisted of two interventions including 1) metformin/prebiotic supplementation BiomeBlissPhase 2 was an open label 4-week extension of metformin/prebiotic supplementation during which all participants were asked to continue taking metformin (850mg) with the prebiotic shake twice daily. After one month (visit 6), participants were evaluated with a protocol that was identical to visits 3 and 5.During Periods 1 and 2, participants were provided with prepared pack-out meals with controlled macronutrient content and dietary fiber. The energy provided was based on estimated energy needs using the Mifflin St Jeor equation and a standard activity factor of 1.3 (