The potential role of lactulose pharmacotherapy in the treatment and prevention of diabetes

Abstract

The non-absorbable disaccharide lactulose is mostly used in the treatment of various gastrointestinal disorders such as chronic constipation and hepatic encephalopathy. The mechanism of action of lactulose remains unclear, but it elicits more than osmotic laxative effects. As a prebiotic, lactulose may act as a bifidogenic factor with positive effects in preventing and controlling diabetes. In this review, we summarized the current evidence for the effect of lactulose on gut metabolism and type 2 diabetes (T2D) prevention. Similar to acarbose, lactulose can also increase the abundance of the short-chain fatty acid (SCFA)-producing bacteria Lactobacillus and Bifidobacterium as well as suppress the potentially pathogenic bacteria Escherichia coli. These bacterial activities have anti-inflammatory effects, nourishing the gut epithelial cells and providing a protective barrier from microorganism infection. Activation of peptide tyrosine tyrosine (PYY) and glucagon-like peptide 1 (GLP1) can influence secondary bile acids and reduce lipopolysaccharide (LPS) endotoxins. A low dose of lactulose with food delayed gastric emptying and increased the whole gut transit times, attenuating the hyperglycemic response without adverse gastrointestinal events. These findings suggest that lactulose may have a role as a pharmacotherapeutic agent in the management and prevention of type 2 diabetes via actions on the gut microbiota.

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“…In recent years, it has become one of the most frequently prescribed medications in the USA, primarily for the treatment of hepatic encephalopathy [47,48]. Moreover, emerging evidence suggests that lactulose may play a role as a pharmacotherapeutic agent in the management and prevention of type 2 diabetes through its effects on gut microbiota [49]. Research conducted by Kishor et.…”

Modern Possibilities of Using Lactulose in Clinical Practice

“…С использованием метода секвенирования 16S-рибосомальной РНК было показано, что одновременное применение лактулозы повышает содержание сахаролитических бактерий (лактобактерий, энтерококков, анаэростипов) и препятствует в таких случаях колонизации кишечника оппортунистической патогенной микрофлорой [31]. Положительное воздействие лактулозы на кишечную микробиоту обусловливает также целесообразность ее применения у больных сахарным диабетом 2-го типа [32].…”