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Can Probiotics Help Prevent Diabetes? New Study Shows Promise

The prevalence of prediabetes is increasing worldwide, and more than 482 million may develop it by 2040 [1]. Prediabetes occurs when blood glucose levels are higher than normal but not high enough to make a diagnosis of type 2 diabetes mellitus (T2DM). Lifestyle interventions that produce weight loss have been shown to reduce the risk of developing T2DM by 30–58% in subjects with prediabetes [2]. However, it has recently been shown that the effectiveness of lifestyle interventions in inducing weight loss as well as glucose management and the occurrence of T2DM is influenced by the composition and function of the individual’s intestinal microbiota [3].

 

Our microbiota can modify the effectiveness of lifestyle interventions to change our weight, health, and risk of disease.

Study Design

In the study, sixty participants (BMI ≥ 25 ; had pre-diabetes or T2DM diagnosed within the previous 12 months) were randomised to receive lifestyle advice and two capsules twice per day of either a multi-strain probiotic or placebo for 12 weeks.

Blood measures were taken at the start and after 12 weeks, along with measures of body composition and stool samples to assess the microbiome.

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The Results

Initial results were not promising. There were no differences between any of their primary or secondary measures between the probiotics and placebos. However, this was not the case when they looked at a subgroup.

 

When they only considered participants that were taking metformin (a drug to help manage diabetes), there were significant beneficial effects of the probiotics. They found a decrease in fasting plasma glucose, insulin resistance, and zonulin protein (a marker of 'leaky gut') was observed, but not within the placebo group.

 

Short chain fatty acid (SCFA) production and/or regulation has been proposed as one of the mechanisms by which probiotics promote health outcomes. Here, the probiotics alone and in combination with metformin also increased the plasma butyrate concentrations and short chain-producing bacteria after the 12-week intervention - which may suggest a possible mechanism for the beneficial findings.

Along with these findings, the abundance of the short chain fatty acid producing bacteria Anaerotruncus colihominis (Cluster IV) was increased only in participants taking both metformin and the probiotic. In participants taking either probiotic or metformin alone, other SCFA-producing bacteria showed an increase in abundance, including Bifidobacterium breve and Dorea logicatena (Cluster XIVa).

 

The Authors Of The Study Concluded That...

"The administration of the multi-strain probiotic with or without metformin was shown to be safe and well tolerated in this pilot study. Although no significant changes in metabolic, inflammatory and permeability markers between the probiotic and placebo groups were observed, significant improvements in the fasting plasma glucose, insulin resistance, and permeability marker zonulin were found in the participants taking metformin and the probiotic together, with beneficial shifts in SCFA-producing bacteria. This study provided suggestive pilot data that probiotics may enhance the efficacy of metformin and regulate butyrate production in those with prediabetes and recently diagnosed T2DM. The findings reported partly clarify the possible mechanisms by which probiotics may assist as an adjunct supplement to metformin in the management of individuals with high blood glucose levels."

References

1 - Ogurtsova, K.; da Rocha Fernandes, J.D.; Huang, Y.; Linnenkamp, U.; Guariguata, L.; Cho, N.H.; Cavan, D.; Shaw, J.E.; Makaroff, L.E. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res. Clin. Pract. 2017, 128, 40–50.

2 - Vita, P.; Cardona-Morrell, M.; Bauman, A.; Singh, M.F.; Moore, M.; Pennock, R.; Snow, J.; Williams, M.; Jackson, L.; Milat, A.; et al. Type 2 diabetes prevention in the community: 12-Month outcomes from the Sydney Diabetes Prevention Program. Diabetes Res. Clin. Pract. 2016, 112, 13–19.

3 - Santacruz, A.; Marcos, A.; Warnberg, J.; Marti, A.; Martin-Matillas, M.; Campoy, C.; Moreno, L.A.; Veiga, O.; Redondo-Figuero, C.; Garagorri, J.M.; et al. Interplay between weight loss and gut microbiota composition in overweight adolescents. Obesity 2009, 17, 1906–1915. [