The PRESCRIBE trial: personalised antioxidant screening and treatment for type 2 diabetes 

Dr Lewan Parker is testing whether antioxidant screening, followed by a personalised treatment strategy, is an accessible and affordable treatment to improve cardiometabolic health and quality of life for people with type 2 diabetes. 

It is the first time such a trial has been conducted and the outcome has the potential to change clinical practice and treatment of chronic disease.  

Antioxidants can be used to treat oxidative stress, which occurs when there is an imbalance between reactive molecules (known as reactive oxygen species) and “neutralising” antioxidants in the body. Oxidative stress is directly linked to the development and progression of cardiovascular disease and type 2 diabetes.  

However, research investigating antioxidant treatment to decrease oxidative stress has been inconsistent.  

Dr Parker believes antioxidant treatment is likely to be more effective when low levels of antioxidants are identified first (antioxidant deficiency screening), and then restored by antioxidants targeting that specific deficiency (personalised antioxidant treatment).  

“Currently, antioxidant screening and personalised treatment are not routinely conducted in research,” Dr Parker explained.  

“This has led to a perpetual cycle of contradictory research findings and prevented advancements in evidence-based antioxidant treatment health practice and policy.” 

In a randomised controlled trial, adults with type 2 diabetes will undergo an antioxidant screening protocol and then receive three months of either personalised antioxidant treatment, generic antioxidant treatment, or a placebo intervention.  

Dr Parker will assess vascular function (cardiac, large artery, and the smallest blood vessels), the ability to walk and exercise (exercise tolerance), insulin resistance, and overall quality of life pre- and post-intervention. 

Through this project, funded by a Heart Foundation Vanguard Grant, Dr Parker hopes to identify whether: 

• Antioxidant deficiencies are varied and unique for people with type 2 diabetes. 
• Specific antioxidant deficiencies and/or patterns are associated with deteriorating vascular dysfunction (cardiac, artery, and/or microvascular), exercise intolerance, and insulin resistance. 
• Antioxidant screening and personalised treatment is a feasible and affordable strategy for improving cardiovascular health and insulin resistance in individuals with type 2 diabetes. 
• Future clinical trials in humans should adopt a personalised antioxidant treatment approach to reliably investigate antioxidants, oxidative stress, and cardiovascular health. 

“Many people with type 2 diabetes have vascular complications including worsening blood sugar control and impaired ability to exercise. They may also experience faster disease progression, and the development of other health complications such as cardiovascular disease over time,” Dr Parker said.  

“We know exercise is great for people with type 2 diabetes, but many find it difficult or painful to do, leading us to investigate other strategies to improve health and quality of life.  

“My hope is that our research will help place personalised interventions at the forefront of healthcare, As a result we’ll have better health outcomes for people with type 2 diabetes and real-world changes in health policy, regulations, and guidelines,” he said.