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Pharmacokinetics of Oral Rebaudioside A in Patients with Type 2 Diabetes Mellitus and Its Effects on Glucose Homeostasis: A Placebo-Controlled Crossover Trial.

  • 2022-09-03
  • European journal of drug metabolism and pharmacokinetics 47(6)
    • Caroline Simoens
    • Koenraad Philippaert
    • Caroline Wuyts
    • Séverine Goscinny
    • Els Van Hoeck
    • Joris Van Loco
    • Jaak Billen
    • Jan de Hoon
    • Els Ampe
    • Roman Vangoitsenhoven
    • Ann Mertens
    • Rudi Vennekens
    • Bart Van der Schueren

Study Design

Type
Randomized Controlled Trial (RCT)
Sample size
n = 30
Population
patients with early-onset type 2 diabetes mellitus (T2DM)
Methods
randomized, placebo-controlled, open-label, two-way crossover trial; oral rebaudioside A (3 g); oral glucose tolerance test (OGTT) performed 19 h following rebaudioside A administration
Blinding
Open-label

Background and objectives

Rebaudioside A, a steviol glycoside, is deglycosylated by intestinal microflora prior to the absorption of steviol and conjugation to steviol glucuronide. While glucose-lowering properties are observed for rebaudioside A in mice, they have been attributed to the metabolites steviol and steviol glucuronide. We aimed to characterize the pharmacokinetic and pharmacodynamic properties of rebaudioside A and its metabolites in patients with early-onset type 2 diabetes mellitus (T2DM).

Methods

This randomized, placebo-controlled, open-label, two-way crossover trial was performed in subjects with T2DM on metformin or no therapy at the University Hospitals Leuven, Belgium. Following oral rebaudioside A (3 g), plasma concentrations of rebaudioside A, steviol and steviol glucuronide were determined. The effect on glucose homeostasis was examined by an oral glucose tolerance test (OGTT) performed 19 h following rebaudioside A administration, i.e. the presumed time of maximal steviol and steviol glucuronide concentrations. The primary pharmacodynamic endpoint was the difference in area under the blood glucose concentration-time curve during the first 2 h of the OGTT (AUCGlucose(0-2h)) for rebaudioside A vs. placebo.

Results

In total, 30 subjects [63.5 (57.8-69.0) years of age, 86.7% male] completed the trial. Rebaudioside A was detected as early as 1 h after administration in nearly all subjects. As expected, steviol and steviol glucuronide reached their maximal concentrations at 19.5 h following rebaudioside A administration. Rebaudioside A did not lower the AUCGlucose(0-2h) compared to placebo (- 0.7 (95% CI - 22.3; 20.9) h·mg/dL, P = 0.95). Insulin and C-peptide concentrations were also comparable between both conditions (P > 0.05).

Conclusion

Rebaudioside A is readily absorbed after oral administration and metabolized to steviol and steviol glucuronide. However, no effect on glucose nor insulin or C-peptide excursion was observed during the OGTT at the time of maximal metabolite concentrations. Thus, no antidiabetic properties of rebaudioside A could be observed in patients with T2DM after single oral use.

Clinical trial registration

Registered on ClinicalTrials.gov (NCT03510624).

Research Insights

  • Stevia→Improved Insulin Levels

    Insulin and C-peptide concentrations were also comparable between both conditions (P > 0.05).

    Effect
    Neutral
    Effect size
    Small
    Dose
    3 g
  • Stevia→Reduced Blood Glucose Levels

    Rebaudioside A did not lower the AUC_Glucose(0-2h) compared to placebo (- 0.7 (95% CI - 22.3; 20.9) h·mg/dL, P = 0.95).

    Effect
    Neutral
    Effect size
    Small
    Dose
    3 g
  • Stevia→Reduced C-Peptide Level

    Insulin and C-peptide concentrations were also comparable between both conditions (P > 0.05).

    Effect
    Neutral
    Effect size
    Small
    Dose
    3 g
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