Impact of intensive lifestyle intervention on gut microbiota composition in type 2 diabetes: a post-hoc analysis of a randomized clinical trial

Abstract

Type 2 diabetes (T2D) management is based on combined pharmacological and lifestyle intervention approaches. While their clinical benefits are well studied, less is known about their effects on the gut microbiota. We aimed to investigate if an intensive lifestyle intervention combined with conventional standard care leads to a different gut microbiota composition compared to standard care alone treatment in individuals with T2D, and if gut microbiota is associated with the clinical benefits of the treatments. Ninety-eight individuals with T2D were randomized to either an intensive lifestyle intervention combined with standard care group (N = 64), or standard care alone group (N = 34) for 12 months. All individuals received standardized, blinded, target-driven medical therapy, and individual counseling. The lifestyle intervention group moreover received intensified physical training and dietary plans. Clinical characteristics and fecal samples were collected at baseline, 3-, 6-, 9-, and 12-month follow-up. The gut microbiota was profiled with 16S rRNA gene amplicon sequencing. There were no statistical differences in the change of gut microbiota composition between treatments after 12 months, except minor and transient differences at month 3. The shift in gut microbiota alpha diversity at all time windows did not correlate with the change in clinical characteristics, and the gut microbiota did not mediate the treatment effect on clinical characteristics. The clinical benefits of intensive lifestyle and/or pharmacological interventions in T2D are unlikely to be explained by, or causally related to, changes in the gut microbiota composition.

A Systematic Review on the Effects of Exercise on Gut Microbial Diversity, Taxonomic Composition, and Microbial Metabolites: Identifying Research Gaps and Future Directions

“…All three groups showed separation in species Bray-Curtis dissimilarity after the 8 wk intervention (Cronin et al, 2018a). In the other study, a one-year lifestyle intervention resulted in an increase in overall richness and Shannon’s index in individuals with type 2 diabetes which was not different from the standard care control (Wei et al, 2022). The only changes unique to the lifestyle intervention groups were observed differences in weighted unifrac measures at 3 months, however this difference between groups was not maintained throughout the whole intervention (Wei et al, 2022).…”

“…Nineteen studies conducted in humans met our inclusion criteria. Of those, 11 included aerobic training interventions (Taniguchi et al, 2018; Morita et al, 2019; Resende et al, 2021; Moitinho-Silva et al, 2021; Mahdieh et al, n.d.; Cheng et al, 2012; Sun et al, 2019; Calabrese et al, 2022; Motiani et al, 2020; Kern et al, 2020; Warbeck et al, 2021), 2 included resistance training interventions (Morita et al, 2019; Moitinho-Silva et al, 2021) and 9 included combined aerobic and resistance training interventions (Cronin et al, 2018a, 2019; Liu et al, 2020; Mokhtarzade et al, 2021; Zhong et al, 2021; Calabrese et al, 2022; Dupuit et al, 2022; Torquati et al, 2022; Wei et al, 2022). Six studies included a high intensity interval training intervention (Liu et al, 2020; Motiani et al, 2020; Warbeck et al, 2021; Dupuit et al, 2022; Sun et al, 2022; Torquati et al, 2022) Included studies varied in design, duration, and populations studied ( Table 1 ).…”

“…Six studies included a high intensity interval training intervention (Liu et al, 2020; Motiani et al, 2020; Warbeck et al, 2021; Dupuit et al, 2022; Sun et al, 2022; Torquati et al, 2022) Included studies varied in design, duration, and populations studied ( Table 1 ). Seventeen studies were trials with a parallel design (2–6 arms) (Cronin et al, 2018a; Morita et al, 2019; Kern et al, 2020; Liu et al, 2020; Motiani et al, 2020; Moitinho-Silva et al, 2021; Mokhtarzade et al, 2021; Resende et al, 2021; Warbeck et al, 2021; Zhong et al, 2021; Calabrese et al, 2022; Cheng et al, 2022; Dupuit et al, 2022; Sun et al, 2022; Torquati et al, 2022; Wei et al, 2022; Mahdieh et al, n.d.), of which the longest trial had a duration of 12 mon (Wei et al, 2022) and the shortest trials had a duration of 2 wk (Motiani et al, 2020). One study followed a crossover design in which participants were exposed to a 5 wk exercise intervention and a 5 wk control (Taniguchi et al, 2018).…”

“…In a prediabetic and diabetic population, both moderate intensity continuous training and sprint interval training for 2 wk decreased the Firmicutes/Bacteroidetes ratio driven by an increase in Bacteroidetes, and decreased genera Blautia and Closridium , while only the moderate continuous training group increased genera Veillonella and Faecalibacterium , and only sprint interval training increased genus Lachnospira (Exercise Training Modulates Gut Microbiota Profile and Improves Endotoxemia..pdf, n.d.). In a diabetic population, a 12-month lifestyle intervention consisting of dietary counseling and exercise decreased the Firmicutes/Bacteroidetes ratio and increased abundance of genera Bacteroides and Roseburia similar to the standard of care (Wei et al, 2022).…”

Editing of a Specific Strain of Escherichia coli in the Mouse Gut Using Native Phages

“…Approximately 1,000 to 1,150 species of bacteria colonize the human intestine, with an average of approximately 160 dominant species in each body. The composition of the gut flora has been correlated with intestinal inflammatory bowel disease, diabetes, asthma, liver disease, obesity, mental illness, and cancer, making it an important metabolic organ ( 6 – 12 ).…”