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Medicina 52 1 — Download references. Department of Community Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.

Obstetrics and Gynecology, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran. Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.

Faculty of Nursing and Midwifery, Department of Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.

You can also search for this author in PubMed Google Scholar. Correspondence to Esmat Mehrabi. Microbiology and Fermentation Technology, Central Food Technological Research Institute, Mysore, Karnataka, India.

Reprints and permissions. Khalili, L. Role of Probiotics in Diabetes Control. In: Sayyed, R. eds Microbiome-Gut-Brain Axis. Springer, Singapore. Published : 03 January Publisher Name : Springer, Singapore. Print ISBN : Online ISBN : eBook Packages : Biomedical and Life Sciences Biomedical and Life Sciences R0.

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Exactly why there is a decrease in beneficial bacteria as Type 2 diabetes develops is unclear. However, a large amount of evidence suggests that a loss of diversity in the gut microbiome leads to a loss of potentially beneficial bacteria and a growth in potentially harmful bacteria.

A probiotic is a live microorganism typically bacteria naturally found in the human body that may provide some sort of health benefit Probiotics can come in many forms, such as foods or as supplements that were deliberately designed to help manage specific health conditions such as Type 2 diabetes.

Prebiotics are compounds—such as dietary fibers—that serve as food for specific species of good bacteria or, in some cases, fungi Because they cannot be digested or absorbed by human cells, prebiotics can be digested by specific forms of beneficial microorganisms.

Many researchers have studied if and how probiotics may help people with Type 2 diabetes, and have found mixed results 13 , 14 , 15 , 16 , The gut microbiome is home to many different bacterial species and there are likely more that we have not yet discovered. Deciphering what effect—if any—each of these species has on the development and progression of Type 2 diabetes typically starts by studying the differences between people with Type 2 diabetes and those without it.

Rodent models for Type 2 diabetes have helped researchers identify a number of different bacterial species that may seem to be involved in protecting us from Type 2 diabetes or, conversely, making us vulnerable to Type 2 diabetes. For example, the species Akkermansia muciniphila has been found to be much less common in microbiome samples taken from people with Type 2 diabetes, suggesting that the absence of this bacterial species may lead to Type 2 diabetes 2 , Studies in humans have shown promising results for probiotics containing various combinations of species, such as:.

Through a combination of DNA testing, in vitro studies, rodent models, and a clinical trial, these bacteria have been shown to help manage blood-sugar levels. When searching for a probiotic to help with Type 2 diabetes, many supplements may be suggested to you.

Only probiotics with scientific and clinical rigor can make these types of claims. Pendulum Glucose Control is only medical probiotic available that has demonstrated clinical efficacy for the dietary management of Type 2 diabetes in people taking metformin.

Fermented foods are foods containing microorganisms bacteria or yeast and that have been changed by the actions of those microorganisms.

In other words, the bacteria or yeast in these foods have eaten some of the nutrients in the food and, in turn, have produced their own molecules. This process accounts for the powerful flavors in kombucha, kimchi, sauerkraut, and tempeh.

Dietary fibers are excellent for this because the human body struggles to digest fibers. However, many species of bacteria in the gut are able to break down fiber and use it to churn out beneficial signaling molecules such as butyrate There are prebiotic elements to many different foods including:.

However, the amount of prebiotic compounds in these foods can be quite small. This is why some probiotics contain the prebiotic inulin or other such prebiotic compounds. Including these in the probiotic can help ensure the bacteria grow once in the gut A clinical trial using 5 strains targeted to help with Type 2 diabetes showed a significant reduction in A1C levels in people with Type 2 diabetes.

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At the end of the screening process, relevant data were independently extracted from studies by the two review authors and any disagreement was resolved by consensus.

Data were extracted into a standardized excel sheet form. Data extracted from the papers included: number of participants, dosage, the intervention used, study duration and the outcome parameters including BMI changes as primary outcome and changes in the total-cholesterol, LDL, TG, HDL, hs-CRP, HbA1C, fasting plasma glucose and insulin levels, SBP and DBP as secondary outcomes.

The authors of the studies and year of publication were also recorded. Mean values for control and intervention groups, along with the measure of dispersion were extracted. Two review authors assessed the risk of bias of the studies independently, and any disagreement was resolved by consensus.

The assessment was performed using the updated version of the Cochrane risk-of-bias tool for randomized trials RoB 2 with the following domains: bias arising from the randomization process, bias due to deviations from intended interventions, bias due to missing outcome data, bias in measurement of the outcome, bias in selection of the reported result, and overall bias We used the Grading of Recommendations, Assessment, Development and Evaluation GRADE approach to rate the quality of evidence on our primary outcomes.

Means were compared by assessing the overlap of CIs. Due to the methodological differences between interventions, we performed all analysis under the random effect assumption.

To assess small study effect, we used visual inspection of funnel plots and Egger's test was performed. We used trial sequential analysis to investigate if alpha and beta-type errors affect our estimates. All analyses were performed with the Comprehensive Meta-analysis software Biostat, Inc.

A flow chart of selection for the meta-analysis is shown in Fig. Main characteristics of the studies included are shown in Table 1. Fifteen studies administered one bacterial species, while the rest of the studies used a combination of more than one strain: seventeen studies administered two to seven bacterial species.

In one article, the flora of the probiotic yoghurt of the intervention group was enriched with specific strains, however placebo yoghurt also contained bacterial flora In three articles, probiotics were co-administered with chromium 35 , 51 , 52 , in one article with selenium 42 , and in one article with vitamin D The duration of intervention ranged from four to 34 weeks.

Seventeen of the 32 articles were published from Iran, two from Saudi Arabia, two from Ukraine, two from Brazil, two from India, and the remaining ones from Malaysia, Denmark, Taiwan, Poland, Sweden, Japan, and Greek.

Data of outcome parameters are summarized in Table 2. The summary of findings table provides a synopsis of the analysis Table 3. One study had high risk overall In seven studies, some concerns were detected; however, we found no articles with any concern about missing outcome data.

The quality of the included studies is shown in detail in Fig. Generally, the quality of the studies was good, in most cases with published pre-study protocols. We found three studies that were single-blind 37 , 51 , 52 , three more studies without blinding 26 , 46 , 48 , all the other articles contained double-blind studies.

Seventeen studies reported BMI changes. Pooled data showed no difference between the probiotic and placebo group. Considerable heterogeneity I 2 : Twenty-one studies included data about the effect of probiotics on total-cholesterol level. Pooled data showed a significant effect of probiotics on reducing total-cholesterol levels with a mean difference of Sub-group analysis according to the length of investigation i.

duration of treatment did not reduce the heterogeneity Fig. Forest plot for the effect of probiotics on total cholesterol T-chol compared to controls in pooled analysis. The shaded diamonds indicate the effect of probiotics in a particular study weighted difference in mean.

The big diamond data marker indicates the pooled effect. The figure shows the summary of studies overall and subdivided by length of intervention. Sub-group analysis according to the number of bacterial strains single or multiple, Fig. The figure shows the summary of studies overall and subdivided by the number of bacterial species used.

If we excluded the six articles where probiotics were co-supplemented with either vitamin D or chromium or selenium, and the article where the placebo group also got yoghurt with some bacteria, the heterogeneity did not change, nor the direction of the association Figure S1.

Twenty studies reported data about LDL levels. Sub-group analysis according to the length of treatment Figure S2 did not decrease the heterogeneity short: I 2 : Sub-group analysis according to the number of bacteria used single or multiple, Figure S3 did not change heterogeneity, either multiple: I 2 : If we excluded the six articles where probiotics were co-supplemented with either vitamin D or chromium or selenium, and the article where the placebo group also got yoghurt with some bacteria, heterogeneity did not change, either Figure S4.

However, based on our trial sequential analysis, a number of 3, observations would be needed to provide sufficient statistical power vs.

the 1, patients in the current analysis Figure S5. The meta-analysis of twenty-one trials showed a significant reduction of triglyceride by The meta-analysis of twenty-two trials showed a significant increase of HDL by 1.

I 2 test The meta-analysis of sixteen trials showed a significant decrease of CRP by 0. Fourteen studies with reported the effect of probiotics on HbA1c levels. Heterogeneity was substantial I 2 : Twenty-four studies reported data about fasting plasma glucose.

Sub-group analysis according to the length of investigation Fig. Forest plot for the effect of probiotics on fasting plasma glucose FPG compared to controls in pooled analysis. Sub-group analysis according to the number of applied bacteria strains single or multiple, Fig. If we excluded the six articles where probiotics were co-supplemented with either vitamin D or chromium or selenium, and the article where the placebo group also got yoghurt with some bacteria, the heterogeneity did not change, either Figure S6.

The meta-analysis of fifteen trials showed a significant reduction of fasting insulin levels by 1. Heterogeneity was not significant Fourteen studies reported data about systolic and diastolic blood pressures.

Since heterogeneity was not significant, no sub-group analysis was performed. In the present meta-analysis, we aimed to evaluate the effects of probiotics on BMI and metabolic parameters in patients with type 2 diabetes mellitus. Data analysis showed a significant effect of probiotics in reduction of total cholesterol, triglyceride levels, CRP, HbA1c, fasting plasma glucose, fasting insulin levels and both systolic and diastolic blood pressure values.

Such an evaluation is of high potential importance, as this patient group has especially high risk of cardiovascular diseases. It is crucial to reduce all the modifiable risk factors with efficient and multifactorial therapeutic methods and probiotic supplementation could be a complementary approach.

High total cholesterol levels, high blood pressure and type 2 diabetes mellitus are major risk factors of cardiovascular diseases.

Reduction of the high total cholesterol and LDL levels in order to reduce the risk of major cardiovascular events is essential Our results show that the consumption of probiotics has a decreasing effect on serum cholesterol levels.

The mechanisms behind this reduction are that probiotics seem to be able to reduce serum cholesterol levels by reducing cholesterol absorption in the intestines 55 and by the inhibition of HMG-CoA reductase enzyme thereby inhibiting endogenous cholesterol synthesis The exact mechanism of action for the beneficial effects of probiotics on glycemia-related parameters is not fully elucidated.

The favorable effects may be due to the immunoregulatory properties of probiotics. Cani et al. demonstrated, that metabolic endotoxemia dysregulates the inflammatory tone and triggers body weight gain and diabetes. Alterations in glucose homeostasis are associated with low-grade inflammation promoted by gut microbiota-derived lipopolysaccharide or endotoxin in mice Therefore, lowering plasma lipopolysaccharide concentration could be a strategy for the control of metabolic diseases, such as diabetes mellitus.

Naito et al. showed that oral administration of Lactobacillus casei strain to obese mice led to a better insulin resistance through decreasing plasma levels of lipopolysaccharide-binding protein, a marker of endotoxemia In our meta-analysis, probiotics significantly reduced total cholesterol, triglyceride levels, CRP levels, HbA1c levels, fasting plasma glucose levels, fasting insulin, and blood pressure together with the increase of the HDL levels.

The observed small changes may not seem to be clinically significant, however the beneficial changes in many parameters can add up leading to a reduction in the severity of type 2 diabetes-related complications, and, as a consequence in lower mortality.

The main strength of our study is that we included exclusively randomized clinical trials for evaluation and the number of the included trials were much higher than in other meta-analyses in this field.

Some of our outcomes triglyceride levels, systolic and diastolic blood pressure values included a homogenous data set, so confounding factors are unlikely to distort our results.

Waist to hip ratio was not measured in most of the articles, so that we could not pool the data. We attempted to determine whether the observed heterogeneity in our outcomes was due to the differences in the length of treatment or in the number of probiotics used.

However, according to our subgroup analyses high heterogeneity still remained unknown. We need more randomized clinical trials to be able to determine the most beneficial bacteria, the optimal dosage and treatment period.

The identified significant heterogeneity is due to the significant differences between the intervention of the selected articles. There are considerable limitations in our study. The diversified settings made it impossible to assess the effect of specific probiotic strains on the analyzed parameters.

Many of the analyzed studies used probiotic mixtures or dairy products containing several probiotic strains. The data of diversity and richness of gut microbiota are absent in some of the included studies. The number of the probiotic species used in the included trials varied between the studies included in the analysis.

The duration of probiotic intervention differed between the included trials. Consequently, substantial heterogeneity was observed between trials within this meta-analysis. No subgroup analysis was possible to assess which particular probiotic preparation could be the most effective to improve metabolic parameters in diabetic patients.

Differences in population or differences in outcome were not considerable. The study aim was to test different cardiometabolic parameters in patients with diabetes mellitus type 2 in all included studies. However, differences in intervention were substantial, due to the fact, that different species or different probiotic combinations were used.

This fact is worth to mention, because we are not able to have high quality evidence due to the very high indirectness. In conclusion, according to our meta-analysis the administration of probiotics has a beneficial role in the management of type 2 diabetes regarding metabolic profile.

We have shown a significant effect of probiotics in reducing total cholesterol, triglyceride levels, CRP, HbA1c, fasting plasma glucose, fasting insulin levels and both systolic and diastolic blood pressure values.

Supplementation with probiotics increased HDL level and it did not had a significant effect on BMI or LDL levels. The practical implication of our study is that probiotic administration as a supportive intervention of type 2 diabetes could be incorporated into diabetes guidelines to beneficially modify cardiometabolic risk factors.

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Gut Microbes. Whorwell PJ, Altringer L, Morel J, et al. Efficacy of an encapsulated probiotic Bifidobacterium infantis in women with irritable bowel syndrome. Am J Gastroenterol. Download references. This research was funded by the National Natural Science Foundation of China No. Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, , China.

College of Food Science and Engineering, South China University of Technology, Guangzhou, , China. Zhongshan Center for Disease Control and Prevention, Zhongshan, , China.

Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-Sen University, Guangzhou, , China. You can also search for this author in PubMed Google Scholar. GL designed and wrote the manuscript with SMX, HF, and XLM.

GL, and YJD performed literature screening and data extraction. GL, HF, XLM, and SMX analyzed and interpreted the data.

XBW, and QZ evaluated the quality of included studies. GL, SMX, HF, XLM, and YG proofread the manuscript. All authors have read and agreed to the published version of the manuscript.

Correspondence to Su-Mei Xiao. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Sensitivity analysis for studies included in this meta-analysis. a FBG, b Insulin, c HbAc1, and d HOMA-IR. Funnel plot for studies included in this meta-analysis.

Open Access This article is licensed under a Creative Commons Attribution 4. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material.

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Li, G. et al. 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.

J Transl Med 21 , Download citation. Received : 18 March Accepted : 24 June Published : 06 July Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative.

Skip to main content. Search all BMC articles Search. Download PDF. 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 , and RCTs about probiotics and T2DM were collected.

Results Thirty RCTs including 1, T2MD patients were identified. Conclusion This study supported that probiotics supplementation had favourable effects on glycaemic control in T2DM patients.

Introduction Type 2 diabetes mellitus T2DM , an endocrine and metabolic disease, is influenced by host physiology and environmental factors [ 1 ]. Methods This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement [ 17 ] Additional file 1 : Table S1.

Data extraction and quality assessment Two researchers Guang Li and Yan-Jun Deng independently performed the literature search and data extraction, and disagreements were resolved by a third senior researcher Su-Mei Xiao. Data synthesis and statistical analysis The change in glycaemic control parameters was the primary outcome in this study.

Results Study characteristics The database search yielded 4, records, and one additional record a conference paper [ 23 ] was obtained from the manual search of the references of the included RCTs. Full size image.

Table 2 Subgroup analysis for the effects of probiotics on FBG Full size table. Table 3 Subgroup analysis for the effects of probiotics on insulin Full size table. Genes Dis 1 2 — Tilg H, Moschen AR Food, immunity, and the microbiome. Gastroenterology 6 — Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI An obesity-associated gut microbiome with increased capacity for energy harvest.

Nature Turnbaugh PJ, Bäckhed F, Fulton L, Gordon JI Diet-induced obesity is linked to marked but reversible alterations in the mouse distal gut microbiome.

Cell Host Microbe 3 4 — Ursell LK, Treuren WV, Metcalf JL, Pirrung M, Gewirtz A, Knight R Replenishing our defensive microbes. Bioessays 35 9 — Vehik K, Dabelea D Why are C-section deliveries linked to childhood type 1 diabetes? Diabetes 61 1 — Wang Q, Würtz P, Auro K, Mäkinen V-P, Kangas AJ, Soininen P, Tiainen M, Tynkkynen T, Jokelainen J, Santalahti K Metabolic profiling of pregnancy: cross-sectional and longitudinal evidence.

BMC Med 14 1 Wen L, Ley RE, Volchkov PY, Stranges PB, Avanesyan L, Stonebraker AC, Hu C, Wong FS, Szot GL, Bluestone JA Innate immunity and intestinal microbiota in the development of Type 1 diabetes. Wendland EM, Torloni MR, Falavigna M, Trujillo J, Dode MA, Campos MA, Duncan BB, Schmidt MI Gestational diabetes and pregnancy outcomes-a systematic review of the World Health Organization WHO and the International Association of Diabetes in Pregnancy Study Groups IADPSG diagnostic criteria.

BMC Pregnancy Childbirth 12 1 Yadav H, Jain S, Sinha P Antidiabetic effect of probiotic dahi containing Lactobacillus acidophilus and Lactobacillus casei in high fructose fed rats. Nutrition 23 1 — Yadav H, Jain S, Sinha P The effect of probiotic dahi containing Lactobacillus acidophilus and Lactobacillus casei on gastropathic consequences in diabetic rats.

J Med Food 11 1 — Yadav H, Lee J-H, Lloyd J, Walter P, Rane SG Beneficial metabolic effects of a probiotic via butyrate-induced GLP-1 hormone secretion.

J Biol Chem 35 — Yang X, Gao X-C, Liu J, Ren H-Y Effect of EPEC endotoxin and bifidobacteria on intestinal barrier function through modulation of toll-like receptor 2 and toll-like receptor 4 expression in intestinal epithelial cell World J Gastroenterol 23 26 Yue B, Luo X, Yu Z, Mani S, Wang Z, Dou W Inflammatory bowel disease: a potential result from the collusion between gut microbiota and mucosal immune system.

Microorganisms 7 10 Article CAS PubMed Central Google Scholar. Zhang Q, Wu Y, Fei X Effect of probiotics on glucose metabolism in patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials.

Medicina 52 1 — Download references. Department of Community Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran. Obstetrics and Gynecology, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.

Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran. Faculty of Nursing and Midwifery, Department of Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.

You can also search for this author in PubMed Google Scholar. Correspondence to Esmat Mehrabi. Microbiology and Fermentation Technology, Central Food Technological Research Institute, Mysore, Karnataka, India.

Reprints and permissions. Khalili, L. Role of Probiotics in Diabetes Control. In: Sayyed, R. eds Microbiome-Gut-Brain Axis. Springer, Singapore. Published : 03 January Publisher Name : Springer, Singapore. Print ISBN : Online ISBN : eBook Packages : Biomedical and Life Sciences Biomedical and Life Sciences R0.

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Policies and ethics. Skip to main content. Keywords Chronic diseases Diabetes Gut microbes Intestinal microbiota Probiotics. Buying options Chapter EUR eBook EUR Softcover Book EUR Hardcover Book EUR Tax calculation will be finalised at checkout Purchases are for personal use only Learn about institutional subscriptions.

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