Can probiotic, prebiotic, and synbiotic supplementation modulate the gut-liver axis in type 2 diabetes? A narrative and systematic review of clinical trials

Abstract

BackgroundType 2 diabetes, one of the most common noncommunicable diseases, is a metabolic disorder that results in failed homeostatic control in several body systems, including hepatic function. Due to the gut microbiome’s potential role in diabetes’ pathogenesis, prebiotics, probiotics, and synbiotics have been proposed as complimentary therapeutic approaches aimed at microbiota readjustment.MethodsA systematic review was conducted on PubMed, Scopus, Web of Science, Embase, and the Cochrane Library examining the effect of probiotics, prebiotics, and synbiotics on hepatic biomarkers in patients with diabetes.ResultsFrom 9,502 search hits, 10 studies met the inclusion criteria and were included in this review. A total of 816 participants (460 intervention and 356 control) were investigated for the effects of nine different hepatic biomarker measurements including aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total protein, bilirubin, liver steatosis, liver stiffness, fatty liver index, and gamma-glutamyl transferase levels. Of the 13 intervention groups analyzed from the 10 studies, 3 were prebiotic interventions, 3 were single species probiotic interventions, 3 were multi-species probiotic interventions, and 4 were synbiotic interventions. Nutraceuticals used in these trials included six genera of bacteria (Lactobacillus, Bifidobacterium, Streptococcus, Acetobacter, Lactococcus, and Propionibacterium), five different prebiotic formulations (inulin, inulin and beta carotene, chicory inulin enriched with oligofructose, galacto-oligosaccharides syrup, and powdered cinnamon), or a combination of these to form multi-species probiotics or synbiotics.ConclusionAlthough some studies showed insignificant changes in hepatic biomarkers, generally the results yielded a decrease in liver damage due to reduced oxidative stress, pro-inflammatory cytokines, gut dysbiosis, and insulin resistance which led to improvements in hepatic biomarker levels.

The Link between Gut Microbiome, Nutraceuticals, Diet, and Diabetes Mellitus: A Bibliometric and Visual Analysis of Research and Emerging Trends from 2012 to 2022

“…Various bacteria have been investigated for their probiotic properties for potential benefit in various deranged aspects of T2DM (694)(695)(696)(697)(698). Bifidobacterium lactis promotes glycogen synthesis and suppresses gluconeogenesis in the liver, in addition to improving glucose uptake.…”

Microbiome‐modulating nutraceuticals ameliorate dyslipidemia in type 2 diabetes: A systematic review, meta‐analysis, and meta‐regression of clinical trials

“…17,18 When used in combination, they are termed synbiotics. With recent links between dysbiosis of the gut and pathology diseases garnering traction across multiple research fields, 19 the potential of homoeostasis modulation of the gut via various nutraceuticals or faecal microbial transplants to ameliorate various metabolic, [20][21][22] neurological, oncological and inflammatory disorders has also garnered interest. [23][24][25][26][27][28][29][30][31][32] Although our understanding of the microbiome increases daily, its therapeutic use still requires considerable undertaking.…”

Renal Health Improvement in Diabetes through Microbiome Modulation of the Gut–Kidney Axis with Biotics: A Systematic and Narrative Review of Randomized Controlled Trials

“…As per the most recent consensus statements of the International Scientific Association for Probiotics and Prebiotics (ISAPP), probiotics are defined as “live microorganisms which when administered in adequate amounts confer a health benefit on the host” [ 23 ]; prebiotics as “a substrate that is selectively utilized by host microorganisms conferring a health benefit” [ 24 ]; and lastly, synbiotics as “a mixture comprising live microorganisms and substrate(s) selectively utilized by host microorganisms that confers a health benefit on the host” [ 25 ]. Previously, we have shown that such nutraceuticals may improve inflammation, oxidative stress, liver damage, glycemia, and insulinemia in T2D patients [ 26 , 27 , 28 ]. Recently, researchers have also successfully investigated their role in obesity-related kidney disease and hypertension [ 29 , 30 ].…”