The effects of probiotics supplementation on glycaemic control among adults with type 2 diabetes mellitus: a systematic review and meta-analysis of randomised clinical trials

Abstract

Objective This systematic review and meta-analysis study aimed to evaluate the effectiveness of probiotics supplementation on glycaemic control in patients with type 2 diabetes mellitus (T2DM) based on the data from the randomised clinical trials (RCTs). Methods PubMed, Web of Sciences, Embase, and Cochrane Library were searched from the inception to October 2022, and RCTs about probiotics and T2DM were collected. The standardised mean difference (SMD) with 95% confidence interval (CI) was used to estimate the effects of probiotics supplementation on glycaemic control related parameters, e.g. fasting blood glucose (FBG), insulin, haemoglobin A1c (HbA1c), and homeostasis model of assessment of insulin resistance (HOMA-IR). Results Thirty RCTs including 1,827 T2MD patients were identified. Compared with the placebo group, the probiotics supplementation group had a significant decrease in the parameters of glycaemic control, including FBG (SMD = − 0.331, 95% CI − 0.424 to − 0.238, Peffect < 0.001), insulin (SMD = − 0.185, 95% CI − 0.313 to − 0.056, Peffect = 0.005), HbA1c (SMD = − 0.421, 95% CI − 0.584 to − 0.258, Peffect < 0.001), and HOMA-IR (SMD = − 0.224, 95% CI − 0.342 to − 0.105, Peffect < 0.001). Further subgroup analyses showed that the effect was larger in the subgroups of Caucasians, high baseline body mass index (BMI ≥ 30.0 kg/m2), Bifidobacterium and food-type probiotics (Psubgroup < 0.050). Conclusion This study supported that probiotics supplementation had favourable effects on glycaemic control in T2DM patients. It may be a promising adjuvant therapy for patients with T2DM.

Recommendations to Improve Quality of Probiotic Systematic Reviews With Meta-Analyses

“…In contrast, pooling data more broadly may be appropriate if the aim is more exploratory, for example, investigating a common mechanism of action that might be expressed across larger taxonomic groups. Underlying characteristics may be shared among taxonomic groups at a species or genus level that drive equivalent efficacy for a shared mechanism of action …”

“…A total of 778 articles were identified by the literature search and 183 probiotic SRMAs were pulled for screening, along with 23 additional studies provided by panel members (total of 206 SRMAs) (Figure 2). A total of 42 representative examples for 11 disease conditions were selected: prevention of antibiotic-associated diarrhea (AAD) (n = 7), [33][34][35][36][37][38][39] treatment of irritable bowel syndrome (n = 9), [40][41][42][43][44][45][46][47][48] treatment of pediatric acute gastroenteritis (n = 10), [49][50][51][52][53][54][55][56][57][58] prevention of postsurgical infections (n = 3), [59][60][61] treatment of atopic dermatitis (n = 3), [62][63][64] prevention of respiratory tract infections (n = 2), 65,66 prevention of neonatal infections (n = 2), 67,68 and mechanistic studies for diabetic metabolism (n = 3), [69][70][71] immune regulation (n = 1), 72 mental health (n = 1), 73 or weight loss (n = 1). 74…”

Maternal Exposure to Endocrine-Disrupting Chemicals: Analysis of Their Impact on Infant Gut Microbiota Composition

“…Bifidobacterium species are widely recognized as crucial contributors to infant health, particularly during the first 6 months of life when exclusive breastfeeding is prevalent, as they play a significant role in immune system development [51,52]. While Bifidobacterium species have acted as probiotics, demonstrating the ability to reduce fasting blood glucose levels and alleviate insulin resistance across various study populations [53], it is worth noting that prior research on type 2 diabetes (T2D) has identified an increase in Bifidobacterium taxa within the gut microbiota of patients [54,55].…”

Exploring a novel therapeutic strategy: the interplay between gut microbiota and high-fat diet in the pathogenesis of metabolic disorders

“…In a study of Dutch adults, it was found that high abundance of butyrate-producing bacteria, including Clostridiaceae 1, Lachnospiraceae, C sensu stricto 1, Intestinibacter , and Romboutsia , is associated with a lower risk of T2DM ( 139 ). By colonizing the gut microbiota or supplementing with probiotics, insulin resistance, body mass index, and gut microbiota composition in T2DM patients can be significantly improved ( 140 , 141 ). A randomized, double-blind, placebo-controlled trial found that a combination probiotic, Probio-X (composed of Lactobacillus casei LCZ, Lactobacillus plantarum P-8, Lactobacillus rhamnosus Probio-M9, Lactobacillus paracasei Probio-M8 , and Lactobacillus paracasei V9 ), can enhance the therapeutic effect of metformin in T2DM by promoting the production of short-chain fatty acids and the bile acid pathway ( 142 ).…”