Introduction
obesity, T2D, pre-diabetes
OBESITY, PRE-DIABETES, TYPE 2 DIABETES
Important risk factors for type 2 diabetes (T2D) include obesity, lack of physical activity, and energy-dense diets [Both glucose and non-nutritive sweeteners may activate receptors in the taste cells leading to a metabolic response, e.g. the release of glucagon-like peptide-1 (GLP-1) [The non-nutritive sweetener stevia (steviol glycoside containing extracts) could be of special interest to people with T2D and potentially to prevent T2D, as stevia has been acknowledged to have glucose-lowering effects [The gut and oral microbiome may play an important role in the various aspects of nutrient sensing [Stevia could serve as an alternative to sucrose, but the entero-endocrine response to stevia remains unknown. Moreover, the influence of the gut and oral microbiome on the entero-endocrine response has not been investigated yet. Therefore, as a proof of concept, our crossover randomized controlled trial (RCT) set out to investigate the entero-endocrine response to a mixed-meal tolerance test performed 20 minutes after nutrient sensing in participants with pre-diabetes (pre-T2D) and T2D. A non-nutritive stevia sweetener was either used for rinsing or swallowed to compare the effect of nutrient sensing in the mouth and in the gut. The main objective was to investigate differences in response between participants with pre-T2D and those with T2D. Next, associations between gut and oral microbiome and the entero-endocrine response were assessed after the swallowed pre-load, thus considering both oral and gut sensing of the pre-load.