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Probiotics for the Management of Diabetes

Can probiotics improve A1c’s, plus much more?

Type 2 diabetes mellitus is a chronic disease caused by insulin resistance and subsequent decline in peripheral glucose uptake. Obesity, sedentary lifestyle, and unhealthy behaviors are the most common risk factors of T2DM. It was estimated that diabetes prevalence was 4% in 2010 and was expected to reach 5.4% by 2025. The problem of T2DM is predicted to double in the near future. T2DM leads to serious complications such as nervous system disorders, kidney diseases, and eye problems; thus prevention and treatment should be considered a priority. For centuries, one of the most effective methods of maintaining the balance of intestinal microbiome was the use of probiotics, defined as live microorganisms which, when administered in sufficient amounts, confer health benefit on the host. Products containing probiotic bacteria have been increasingly utilized to prevent or treat numerous disorders such as irritable bowel syndrome, inflammatory bowel disease, and chronic idiopathic constipation, obesity, allergic and pulmonary disease, and various types of diarrhea. It has been suggested that probiotics may positively modify metabolic disturbance. There are evidence that probiotic ingestion or supplementation might decrease serum cholesterol level and improve insulin sensitivity. Some studies have evaluated the positive health effects of probiotic dairy products.

The purpose of this study is to assess probiotics for the management of diabetes: the ability of probiotics to modify cardio metabolic risk factors in type 2 diabetic subjects. It was performed according to PRISMA guidelines. Randomized controlled trials were used in adults with T2DM. The outcomes of interest were fasting plasma glucose (FPG), insulin concentration, insulin resistance estimated using the homeostatic model assessment, HbA1c, total cholesterol 9TC), high density lipoprotein (HDL) and C reactive protein (CRP). These endpoints were extracted from studies and collated in a computer spreadsheet. Statistical analysis was conducted with STATISTICA version 10. A total of 8 RCT with 38 subjects met the inclusion criteria and were included in the meta-analysis. 5 of the 6 RCTs showed a significant reduction of FPG after consumption of probiotics while only 1 did not (I2 = 97.66%; P<0.001). HbA1c showed a decreased level after the receiving probiotics as compared with receiving placebo (I2 = 68.44%, P + 0.0421). Also, there was a decrease in insulin levels upon probiotic consumption, but no significant difference in mean insulin levels was observed between probiotic and placebo users (I2 = 96.49%; P < 0.001). Cholesterol, low density lipoprotein cholesterol, and CRP did not show any significant change upon the consumption of probiotics. However, triglycerides and high density lipoprotein cholesterol showed positive changes to the consumption of probiotics.

Some of the limitations of this study were the fact that the number of identified RCTs that met the inclusion criteria was relatively low, and that made the broadening settings difficult to assess the effect of a particular probiotics strain. In conclusion, this meta-analysis of available RCT suggests that probiotic supplementation has a beneficial effect on selected cardio metabolic parameters in patients with T2DM. Larger well-designed studies are however needed to determine the true relationship between probiotic supplementation and modifiable cardio metabolic risk factors before it should be recommended as a supportive treatment in T2DM.

Another parallel group controlled clinical trial was conducted to determine the effects of C. ficifolia and/or probiotic yogurt consumption on glycemic control, lipid profile and inflammatory markers in T2DM patients. Eligible criteria were age between 25 and 75 years, fasting blood sugar (FBS) more than 126mg/dL and a controlled lipid without changing the drug instruction. Participants were assigned to one of the four dietary arms lasting 8 weeks. The intervention included 1) C. ficifolia (100 g); 2) probiotic yogurt (150 g); 3) C. ficifolia and probiotic yogurt (100 g  C ficifolia plus 150 g yogurt); and 4) control (dietary advice). C. ficifolia and yogurt were consumed at lunch time and patients were asked not to change their dietary habits. Blood samples were obtained at baseline and at the end of study. ANOVA and Chi-square were used for their statistical analysis with 80 subjects completing the study. There were no significant changes in TC and LDL-C in the control group but TG increased (P = 0.012) and HDL-C decreased (P = 0.034) significantly. All interventions however decreased FBS (P = 0.001 in pumpkin, P = 0.014 in yogurt, and P < 0.001 in C. ficifolia plus yogurt) and HbA1c (P < 0.001 in C. ficifolia, P = 0.002 in yogurt, P = 0.000 in C. ficifolia plus yogurt) in comparison with control group (between group P, 0.001 and < 0.001, respectively).

In conclusion, probiotic yogurt and C. ficifolia alone or together have beneficial effects on lipid profile, glycemic control, inflammation and blood pressure in T2DM patients.

Practice Pearls:

  • Probiotics play a major role in our health.
  • Probiotics are live microorganisms which when administered in adequate amounts confer a health benefit on the host.
  • Probiotic supplementation has beneficial effect on selected cardio metabolic parameters in patients with T2D.

References:

Bayat, Azade et al. “Effect of Cucurbita Ficifolia and Probiotic Yogurt Consumption on Blood Glucose, Lipid Profile, and Inflammatory Marker in Type 2 Diabetes.” International Journal of Preventive Medicine 7 (2016): 30. PMC. Web. 17 July 2016.

Kasińska, Marta A, and Józef Drzewoski “Effectiveness of Probiotics in Type 2 Diabetes: A Meta-Analysis.” Polskie Archiwum Medycyny Wewnętrznej 125.11 (2015): 803-813. MEDLINE with Full Text. Web. 17 July 2016.