Sulforaphane reduces fasting blood glucose in prediabetes

There is a large need for more effective treatment of prediabetes and improved understanding of the heterogeneity of treatment response. Sulforaphane is an isothiocyanate that reduces hepatic gluconeogenesis and is well tolerated when provided as a broccoli sprout extract (BSE), making it warranted to test its efficacy as an early intervention in prediabetes. We conducted a randomized trial of individuals with impaired fasting glucose and found that BSE significantly reduced fasting blood glucose compared with placebo. Furthermore, a data-driven cluster analysis identified three pathophysiological subgroups of impaired fasting glucose with different microbiota composition. Individuals of the largest subgroup, characterized by mild obesity, low insulin resistance and reduced insulin secretion, had a pronounced treatment response. The pronounced responders had also higher abundance of Bacteroides that convert the inactive precursor to bioactive sulforaphane. The findings highlight sulforaphane-containing BSE as a new modality for early anti-hyperglycemic intervention and enable a strategy for precision treatment of prediabetes based on the individual pathophysiology and gut microbiota.