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Various clinical trials have demonstrated the promising effects of L-carnitine on insulin sensitivity and/or glucose tolerance ( Several mechanisms are suggested for the beneficial impacts of L-carnitine on glucose homeostasis, including improving insulin sensitivity, enhancing glucose utilization, modulating the gluconeogenic and glycolytic enzymes expression, altering the insulin signaling cascade gene expression, and stimulating the insulin-like growth factor 1 (IGF-1) axis and IGF-1 signaling cascade (79), since within cellular aggregation of acyl-CoA derivates is stated to be involved in impairing insulin signaling, inducing insulin resistance in the heart and skeletal muscle (79), also modulating the intramitochondrial acetyl-CoA/CoA ratio ( It has been clarified in several clinical trials that pro/pre/synbiotics might improve glucose homeostasis features (77, 80)

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