Specific alterations of gut microbiota in diabetic microvascular complications: A systematic review and meta-analysis

Abstract

BackgroundThe role of gut microbiota in diabetes mellitus (DM) and its complications has been widely accepted. However, the alternation of gut microbiota in diabetic microvascular complications (DC) remains to be determined.MethodsPublications (till August 20th, 2022) on gut microbiota in patients with DC were retrieved from PubMed, Web of Science, Embase and Cochrane. Review Manager 5.3 was performed to estimate the standardized mean difference (SMD) and 95% confidence interval (CI) and calculate alpha diversity indices and the relative abundance of gut microbiota between patients in DC v.s. DM and DC v.s. healthy controls (HC).ResultsWe included 13 studies assessing 329 patients with DC, 232 DM patients without DC, and 241 HC. Compared to DM, patients with DC shared a significantly lower Simpson index (SMD = -0.59, 95% CI [-0.82, -0.36], p < 0.00001), but a higher ACE index (SMD = 0.42, 95% CI[0.11, 0.74], p = 0.009). Compared to HC, DC patients held a lower ACE index (SMD = -0.61, 95% CI[-1.20, -0.02], p = 0.04). The relative abundances of phylum Proteobacteria (SMD = 0.03, 95% CI[0.01, 0.04], p = 0.003, v.s. HC) and genus Klebsiella (SMD = 0.00, 95% CI[0.00, 0.00], p < 0.00001, v.s. HC) were enriched, accompanying with depleted abundances of phylum Firmicutes (SMD = -0.06, 95% CI[-0.11, -0.01], p = 0.02, v.s. HC), genera Bifidobacterium (SMD = -0.01, 95% CI[-0.02,-0.01], p < 0.0001, v.s. DM), Faecalibacterium (SMD = -0.01, 95% CI[-0.02, -0.00], p = 0.009, v.s. DM; SMD = -0.02, 95% CI[-0.02, -0.01], p < 0.00001, v.s. HC) and Lactobacillus (SMD = 0.00, 95% CI[-0.00, -0.00], p < 0.00001, v.s. HC) in DC.ConclusionsGut microbiota perturbations with the depletion of alpha diversity and certain short-chain fatty acids (SCFAs)-producing bacteria were associated with the pathology of DC. Therefore, gut microbiota might serve as a promising approach for the diagnosis and treatment of DC. Further investigations are required to study the mechanisms by which gut dysbiosis acts on the onset and progression of DC.

Advances in fecal microbiota transplantation for the treatment of diabetes mellitus

“…In addition to sharing the metabolic pathways of DM, researchers have found that diabetic complications are associated with specific metabolite levels ( Ma et al., 2024 ). Therefore, the microbiota influences variations in intestinal microecology in DM microangiopathy and is involved in the progression and prognosis of disease ( Hong et al., 2022 ).…”

“…Specifically, Bifidobacteria , Bacteroides , and Coprologis are negatively correlated with DM, whereas Ruminococcus , Fusobacterium , and Cyanobacteria are positively correlated. Diabetic microangiopathosis is positively correlated with Bacteroides abundance and negatively correlated with Prevotella abundance ( Hong et al., 2022 ; Li et al., 2023 ; Sapra and Bhandari, 2023 ; Jia et al., 2024 ; Kanbour et al., 2024 ; Ma et al., 2024 ). Pasteurella bacteria can be used as a microbial feature to distinguish DR from DM, and Blautia may be a protective factor against DN.…”