Considering gut microbiota in treatment of type 2 diabetes mellitus

Adeshirlarijaney, Aneseh; Gewirtz, Andrew T.

doi:10.1080/19490976.2020.1717719

Cited by 98 publications

(90 citation statements)

References 84 publications

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“…Of the 17 human studies selected, the majority of these studies focus on either newly diagnosed or prevalent T2D patients, and directed toward investigating the interplay of metformin, and to a lesser extent, acarbose, with gut microbiota. Our results suggest that these two drugs mediate their glucose-lowering effect, in part, by stimulating beneficial gut bacteria that could produce metabolites to promote intestinal homeostasis (3,9). We rationalize that alterations in gut microbiota compositions might also underlie the gastrointestinal side effects known to metformin, i.e., diarrhea and fecal incontinence (10,25,80).…”

Section: Discussionmentioning

confidence: 61%

“…From a clinical perspective, these findings provide a rationale for targeting gut microbiota imbalance as a potential strategy for T2D treatment by restoring a healthy gut microbiome, including fecal microbiota transplant and probiotic supplements (3,4). However, the efficiency and effectiveness of these treatments remain uncertain due to concerns over the invasive nature of fecal microbiota transplant and the dosage, species, and duration required for an effective probiotic treatment.…”

Section: Introductionmentioning

confidence: 99%

“…However, the efficiency and effectiveness of these treatments remain uncertain due to concerns over the invasive nature of fecal microbiota transplant and the dosage, species, and duration required for an effective probiotic treatment. Emerging evidence indicates that the therapeutic efficacy of anti-hyperglycemic drugs might, in part, be attributable to their ability to modulate the compositions of gut microbiota ( 1 , 3 , 5 – 9 ). This compositional change might lead to enrichments in bacterial species exhibiting beneficial effects to intestinal health via the production of health-promoting metabolites, such as short-chain fatty acids (SCFAs) and bile acids ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effects of Non-insulin Anti-hyperglycemic Agents on Gut Microbiota: A Systematic Review on Human and Animal Studies

Cao

Hsu

et al. 2020

Front. Endocrinol.

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Background: As growing evidence links gut microbiota with the therapeutic efficacy and side effects of anti-hyperglycemic drugs, this article aims to provide a systematic review of the reciprocal interactions between anti-hyperglycemic drugs and gut microbiota taxa, which underlie the effect of the gut microbiome on diabetic control via bug-host interactions. Method: We followed the PRISMA requirements to perform a systematic review on human vs. animal gut microbiota data in PubMed, SCOPUS, and EMBASE databases, and used Cochrane, ROBIN-I, and SYRCLE tools to assess potential bias risks. The outcomes of assessment were trends on gut microbiota taxa, diversity, and associations with metabolic control (e.g., glucose, lipid) following anti-hyperglycemic treatment. Results: Of 2,804 citations, 64 studies (17/humans; 47/mice) were included. In human studies, seven were randomized trials using metformin or acarbose in obese, pre-diabetes, and type 2 diabetes (T2D) patients. Treatment of pre-diabetes and newly diagnosed T2D patients with metformin or acarbose was associated with decreases in genus of Bacteroides, accompanied by increases in both Bifidobacterium and Lactobacillus. Additionally, T2D patients receiving metformin showed increases in various taxa of the order Enterobacteriales and the species Akkermansia muciniphila. Of seven studies with significant differences in beta-diversity, the incremental specific taxa were associated with the improvement of glucose and lipid profiles. In mice, the effects of metformin on A. muciniphila were similar, but an inverse association with Bacteroides was reported. Animal studies on other anti-hyperglycemic drugs, however, showed substantial variations in results. Cao et al. Anti-hyperglycemic Drugs and Gut Microbiota Conclusions: The changes in specific taxa and β-diversity of gut microbiota were associated with metformin and acarbose in humans while pertinent information for other anti-hyperglycemic drugs could only be obtained in rodent studies. Further human studies on anti-hyperglycemic drugs other than metformin and acarbose are needed to explore gut microbiota's role in their therapeutic efficacies and side effects.

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Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of Non-insulin Anti-hyperglycemic Agents on Gut Microbiota: A Systematic Review on Human and Animal Studies

Cao

Hsu

et al. 2020

Front. Endocrinol.

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“…Xu et al have shown that Faecalibacterium prausnitzii, one of the most frequent commensal bacteria in normal individuals with essential roles in gut homeostasis, generates anti-inflammatory molecules that enhance the expression of tight junctions and improve intestinal integrity during diabetes (77). However, in some cases, gut microbiota dysbiosis or altered microbial composition of the intestines could induce T2DM and lead to its progression (78).…”

Section: Gastrointestinal Tract (Git)mentioning

confidence: 99%

The Effects of Type 2 Diabetes Mellitus on Organ Metabolism and the Immune System

et al. 2020

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Metabolic abnormalities such as dyslipidemia, hyperinsulinemia, or insulin resistance and obesity play key roles in the induction and progression of type 2 diabetes mellitus (T2DM). The field of immunometabolism implies a bidirectional link between the immune system and metabolism, in which inflammation plays an essential role in the promotion of metabolic abnormalities (e.g., obesity and T2DM), and metabolic factors, in turn, regulate immune cell functions. Obesity as the main inducer of a systemic low-level inflammation is a main susceptibility factor for T2DM. Obesity-related immune cell infiltration, inflammation, and increased oxidative stress promote metabolic impairments in the insulin-sensitive tissues and finally, insulin resistance, organ failure, and premature aging occur. Hyperglycemia and the subsequent inflammation are the main causes of micro-and macroangiopathies in the circulatory system. They also promote the gut microbiota dysbiosis, increased intestinal permeability, and fatty liver disease. The impaired immune system together with metabolic imbalance also increases the susceptibility of patients to several pathogenic agents such as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Thus, the need for a proper immunization protocol among such patients is granted. The focus of the current review is to explore metabolic and immunological abnormalities affecting several organs of T2DM patients and explain the mechanisms, whereby diabetic patients become more susceptible to infectious diseases.

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“…[ 67 , 68 ] Conversely, probiotics have been shown to affect gut microbiota and improve glucose homeostasis. [ 69 ] How does the gut microbiota influence metabolism? Studies have indicated that the microbiota modulates inflammation, interacts with dietary constituents, regulates the circadian clock, and affects gut permeability, insulin sensitivity, and even overall energy homeostasis.…”

Section: Potential Factors Mediating the Effects Of The Intestinal MImentioning

confidence: 99%

Potential contribution of the gut microbiota to hypoglycemia after gastric bypass surgery

Zhou

Deng

Xiao

2020

Chinese Medical Journal

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Obesity has become a global health problem. Lifestyle modification and medical treatment only appear to yield short-term weight loss. Roux-en-Y gastric bypass (RYGB) is the most popular bariatric procedure, and it sustains weight reduction and results in the remission of obesity-associated comorbidities for obese individuals. However, patients who undergo this surgery may develop hypoglycemia. To date, the diagnosis is challenging and the prevalence of post-RYGB hypoglycemia (PRH) is unclear. RYGB alters the anatomy of the upper gastrointestinal tract and has a combined effect of caloric intake restriction and nutrient malabsorption. Nevertheless, the physiologic changes after RYGB are complex. Although hyperinsulinemia, incretin effects, dysfunction of β-cells and α-cells, and some other factors have been widely investigated and are reported to be possible mediators of PRH, the pathogenesis is still not completely understood. In light of the important role of the gut microbiome in metabolism, we hypothesized that the gut microbiome might also be a critical link between RYGB and hypoglycemia. In this review, we mainly highlight the current possible factors predisposing individuals to PRH, particularly related to the gut microbiota, which may yield significant insights into the intestinal regulation of glucose metabolic homeostasis and provide novel clues to improve the treatment of type 2 diabetes mellitus.

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Considering gut microbiota in treatment of type 2 diabetes mellitus

Cited by 98 publications

References 84 publications

Effects of Non-insulin Anti-hyperglycemic Agents on Gut Microbiota: A Systematic Review on Human and Animal Studies

Effects of Non-insulin Anti-hyperglycemic Agents on Gut Microbiota: A Systematic Review on Human and Animal Studies

The Effects of Type 2 Diabetes Mellitus on Organ Metabolism and the Immune System

Potential contribution of the gut microbiota to hypoglycemia after gastric bypass surgery

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