Modulating gut microbiota in the management of type 2 diabetes mellitus: a narrative review

Authors

  • Meirajuddin Tousif Department of General Medicine, Sri Devaraj Urs Medical College, Karnataka, India
  • Maria Akhtar Department of Medicine, Khaja Bandawaz Institute of Medical Sciences, Karnataka, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20241586

Keywords:

Gut microbiota, Type 2 diabetes mellitus, Modulation, Probiotics, Prebiotics, Dietary interventions, Fecal microbiota transplantation, Glycemic control, Metabolic health

Abstract

Type 2 diabetes mellitus (T2DM) represents a significant global health burden, necessitating innovative therapeutic approaches. Recent research has increasingly recognized the role of gut microbiota modulation in T2DM management, offering promising avenues for intervention. This systematic review synthesizes current literature investigating the impact of modulating gut microbiota on T2DM management. A comprehensive search of databases yielded studies examining various strategies, including probiotics, prebiotics, dietary interventions, and facal microbiota transplantation. Analysis of these interventions revealed their potential to improve glycemic control, insulin sensitivity, and inflammation markers in individuals with T2DM. Mechanistic insights elucidate how gut microbiota modulation influences metabolic pathways, immune function, and gut barrier integrity, thereby contributing to T2DM pathophysiology. Furthermore, studies highlight the interplay between gut microbiota composition and host factors such as diet, lifestyle, and genetics, underscoring the complexity of this relationship. Modulating gut microbiota presents a promising therapeutic approach in T2DM management, with potential benefits in glycemic control and metabolic health. However, further research is warranted to optimize intervention strategies, elucidate mechanistic pathways, and explore long-term effects. The aim of this review was to underscores the importance of considering gut microbiota modulation as a complementary approach in the multifaceted management of T2DM.

 

References

Zhao L, Lou H, Peng Y, Chen S, Fan L, Li X. Elevated levels of circulating short-chain fatty acids and bile acids in type 2 diabetes are linked to gut barrier disruption and disordered gut microbiota. Diabetes Res Clin Pract. 2020;169:108418.

Almugadam BS, Liu Y, Chen SM, Wang CH, Shao CY, Ren BW, et al. Alterations of Gut Microbiota in Type 2 Diabetes Individuals and the Confounding Effect of Antidiabetic Agents. J Diabetes Res. 2020;2020:7253978.

Umirah F, Neoh CF, Ramasamy K, Lim SM. Differential gut microbiota composition between type 2 diabetes mellitus patients and healthy controls: A systematic review. Diabetes Res Clin Pract. 2021;173:108689.

Zhou Z, Sun B, Yu D, Zhu C. Gut Microbiota: An Important Player in Type 2 Diabetes Mellitus. Front Cell Infect Microbiol. 2022;12:834485.

Dao MC, Everard A, Aron-Wisnewsky J, Sokolovska N, Prifti E, Verger E, et al. Akkermansia muciniphila and improved metabolic health during a dietary intervention in obesity: relationship with gut microbiome richness and ecology. Gut. 2016;65(3):426-36.

Cani PD, Amar J, Iglesias MA, Poggi M, Knauf C, Bastelica D, et al. Metabolic endotoxemia initiates obesity and insulin resistance. Diabetes. 2007;56(7):1761-72.

Koh A, De Vadder F, Kovatcheva-Datchary P, Bäckhed F. From Dietary Fiber to Host Physiology: Short-Chain Fatty Acids as Key Bacterial Metabolites. Cell. 2016;165(6):1332-45.

Palmnäs-Bédard MSA, Costabile G, Vetrani C, Åberg S, Hjalmarsson Y, Dicksved J, et al. The human gut microbiota and glucose metabolism: a scoping review of key bacteria and the potential role of SCFAs. Am J Clin Nutr. 2022;116(4):862-74.

Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. 2006;444(7122):1027-31.

Zhao L, Zhang F, Ding X, Wu G, Lam YY, Wang X, et al. Gut bacteria selectively promoted by dietary fibers alleviate type 2 diabetes. Science. 2018;359(6380):1151-6.

Lau W, Vaziri N. Gut microbial short-chain fatty acids and the risk of diabetes. Nature Reviews Nephrology. 2019;15(7):389-90.

Koh A, De Vadder F, Kovatcheva-Datchary P, Bäckhed F. From Dietary Fiber to Host Physiology: Short-Chain Fatty Acids as Key Bacterial Metabolites. Cell. 2016;165(6):1332-45.

Gao L. A study on the relationship among dietary fiber intake, type 2 diabetes, microbiota and immune system. Highlights in Science Engineering and Technology. 2022;19:51-7.

Tan J, McKenzie C, Potamitis M, Thorburn AN, Mackay CR, Macia L. The role of short-chain fatty acids in health and disease. Adv Immunol. 2014;121:91-119.

Gao Z, Yin J, Zhang J, Ward RE, Martin RJ, Lefevre M, et al. Butyrate improves insulin sensitivity and increases energy expenditure in mice. Diabetes. 2009;58(7):1509-17.

Peng L, Li ZR, Green RS, Holzman IR, Lin J. Butyrate enhances the intestinal barrier by facilitating tight junction assembly via activation of AMP-activated protein kinase in Caco-2 cell monolayers. J Nutr. 2009;139(9):1619-25.

Hamer HM, Jonkers DM, Vanhoutvin SA, Troost FJ, Rijkers G, de Bruïne A, et al. Effect of butyrate enemas on inflammation and antioxidant status in the colonic mucosa of patients with ulcerative colitis in remission. Clin Nutr. 2010;29(6):738-44.

Zhang J, Zhang H, Deng X. Butyrate inhibits the proliferation and induces the apoptosis of colorectal cancer cells via modulating of miR-22/SIRT1 pathway. Gene. 2020;739:144500.

Psichas A, Sleeth ML, Murphy KG, Brooks L, Bewick GA, Hanyaloglu AC, et al. The short chain fatty acid propionate stimulates GLP-1 and PYY secretion via free fatty acid receptor 2 in rodents. Int J Obes (Lond). 2015;39(3):424-9.

Alberto González-Regueiro J, Moreno-Castañeda L, Uribe M, Carlos Chávez-Tapia N. The Role of Bile Acids in Glucose Metabolism and Their Relation with Diabetes. Ann Hepatol. 2017;16(1):S15-20.

Shapiro H, Kolodziejczyk AA, Halstuch D, Elinav E. Bile acids in glucose metabolism in health and disease. J Exp Med. 2018;215(2):383-96.

Liu J, Tan Y, Cheng H, Zhang D, Feng W, Peng C. Functions of Gut Microbiota Metabolites, Current Status and Future Perspectives. Aging Dis. 2022;13(4):1106-26.

Vrieze A, Van Nood E, Holleman F, Salojärvi J, Kootte RS, Bartelsman JF, et al. Transfer of intestinal microbiota from lean donors increases insulin sensitivity in individuals with metabolic syndrome. Gastroenterology. 2012;143(4):913-6.

Karlsson FH, Tremaroli V, Nookaew I, Bergström G, Behre CJ, Fagerberg B, et al. Gut metagenome in European women with normal, impaired and diabetic glucose control. Nature. 2013;498(7452):99-103.

Cani PD, Amar J, Iglesias MA, Poggi M, Knauf C, Bastelica D, et al. Metabolic endotoxemia initiates obesity and insulin resistance. Diabetes. 2007;56(7):1761-72.

Sayin SI, Wahlström A, Felin J, Jäntti S, Marschall HU, Bamberg K, et al. Gut microbiota regulates bile acid metabolism by reducing the levels of tauro-beta-muricholic acid, a naturally occurring FXR antagonist. Cell Metab. 2013;17(2):225-35.

Cotillard A, Kennedy SP, Kong LC, Prifti E, Pons N, Le Chatelier E, et al. Dietary intervention impact on gut microbial gene richness. Nature. 2013;500(7464):585-8.

Wu GD, Chen J, Hoffmann C, Bittinger K, Chen YY, Keilbaugh SA, et al. Linking long-term dietary patterns with gut microbial enterotypes. Science. 2011;334(6052):105-8.

Ley RE, Turnbaugh PJ, Klein S, Gordon JI. Microbial ecology: human gut microbes associated with obesity. Nature. 2006;444(7122):1022-3.

Turnbaugh PJ, Hamady M, Yatsunenko T, Cantarel BL, Duncan A, Ley RE, et al. A core gut microbiome in obese and lean twins. Nature. 2009;457(7228):480-4.

Larsen N, Vogensen FK, Berg FW, Nielsen DS, Andreasen AS, Pedersen BK, et al. Gut microbiota in human adults with type 2 diabetes differs from non-diabetic adults. PLoS One. 2010;5(2):e9085.

Qin J, Li Y, Cai Z, Li S, Zhu J, Zhang F, et al. A metagenome-wide association study of gut microbiota in type 2 diabetes. Nature. 2012;490(7418):55-60.

Karlsson FH, Tremaroli V, Nookaew I, Bergström G, Behre CJ, Fagerberg B, et al. Gut metagenome in European women with normal, impaired and diabetic glucose control. Nature. 2013;498(7452):99-103.

Wu H, Esteve E, Tremaroli V, Khan MT, Caesar R, Mannerås-Holm L, et al. Metformin alters the gut microbiome of individuals with treatment-naive type 2 diabetes, contributing to the therapeutic effects of the drug. Nat Med. 2017;23(7):850-8.

Zhang X, Shen D, Fang Z, Jie Z, Qiu X, Zhang C, Chen Y, et al. Human gut microbiota changes reveal the progression of glucose intolerance. PLoS One. 2013;8(8):e71108.

Huda MN, Kim M, Bennett BJ. Modulating the Microbiota as a Therapeutic Intervention for Type 2 Diabetes. Front Endocrinol (Lausanne). 2021;12:632335.

Wu J, Yang K, Fan H, Wei M, Xiong Q. Targeting the gut microbiota and its metabolites for type 2 diabetes mellitus. Front Endocrinol (Lausanne). 2023;14:1114424.

Gurung M, Li Z, You H, Rodrigues R, Jump DB, Morgun A, et al. Role of gut microbiota in type 2 diabetes pathophysiology. EBioMedicine. 2020;51:102590.

Ghosh TS, Valdes AM. Evidence for clinical interventions targeting the gut microbiome in cardiometabolic disease. BMJ. 2023;383:e075180.

Gurung M, Li Z, You H, Rodrigues R, Jump DB, Morgun A, et al. Role of gut microbiota in type 2 diabetes pathophysiology. EBioMedicine. 2020;51:102590.

Wu J, Yang K, Fan H, Wei M, Xiong Q. Targeting the gut microbiota and its metabolites for type 2 diabetes mellitus. Front Endocrinol (Lausanne). 2023;14:1114424.

Kunasegaran T, Balasubramaniam VRMT, Arasoo VJT, Palanisamy UD, Ramadas A. The Modulation of Gut Microbiota Composition in the Pathophysiology of Gestational Diabetes Mellitus: A Systematic Review. Biology (Basel). 2021;10(10):1027.

Erejuwa OO, Sulaiman SA, Ab Wahab MS. Modulation of gut microbiota in the management of metabolic disorders: the prospects and challenges. Int J Mol Sci. 2014;15(3):4158-88.

Han JL, Lin HL. Intestinal microbiota and type 2 diabetes: from mechanism insights to therapeutic perspective. World J Gastroenterol. 2014;20(47):17737-45.

Sonnenburg ED, Sonnenburg JL. Starving our microbial self: the deleterious consequences of a diet deficient in microbiota-accessible carbohydrates. Cell Metab. 2014;20(5):779-86.

Rastelli M, Knauf C, Cani PD. Gut Microbes and Health: A Focus on the Mechanisms Linking Microbes, Obesity, and Related Disorders. Obesity (Silver Spring). 2018;26(5):792-800.

Khan MJ, Gerasimidis K, Edwards CA, Shaikh MG. Role of Gut Microbiota in the Aetiology of Obesity: Proposed Mechanisms and Review of the Literature. J Obes. 2016;2016:7353642.

Kallapura G, Prakash AS, Sankaran K, Manjappa P, Chaudhary P, Ambhore S, et al. Microbiota based personalized nutrition improves hyperglycaemia and hypertension parameters and reduces inflammation: A prospective, open label, controlled, randomized, comparative, proof of concept study. MedRxiv. 2023.

Xu TC, Liu Y, Yu Z, Xu B. Gut-targeted therapies for type 2 diabetes mellitus: A review. World J Clin Cases. 2024;12(1):1-8.

Du L, Li Q, Yi H, Kuang T, Tang Y, Fan G. Gut microbiota-derived metabolites as key actors in type 2 diabetes mellitus. Biomed Pharmacother. 2022;149:112839.

Liu L, Zhang J, Cheng Y, Zhu M, Xiao Z, Ruan G, et al. Gut microbiota: A new target for T2DM prevention and treatment. Front Endocrinol (Lausanne). 2022;13:958218.

Liu L, Zhang J, Cheng Y, Zhu M, Xiao Z, Ruan G, Wei Y. Gut microbiota: A new target for T2DM prevention and treatment. Front Endocrinol (Lausanne). 2022;13:958218.

Downloads

Published

2024-05-31

How to Cite

Tousif, M., & Akhtar, M. (2024). Modulating gut microbiota in the management of type 2 diabetes mellitus: a narrative review. International Journal of Research in Medical Sciences, 12(6), 2179–2185. https://doi.org/10.18203/2320-6012.ijrms20241586

Issue

Section

Review Articles