Hu Yi-Meng, Zhou Feng, Yuan Yin, Xu Yan-Cheng
Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
Med Clin (Barc). 2017 Apr 21;148(8):362-370. doi: 10.1016/j.medcli.2016.11.036. Epub 2017 Feb 22.
To objectively evaluate the effects of probiotics supplement on glycemic control and lipid metabolism in patients with type 2 diabetes mellitus (T2DM).
The randomized controlled trials (RCTs) with regard to the probiotics or synbiotics for the treatment of T2DM were collected through retrieving 5 databases from their establishment to March 2016. After study selection, quality assessment and data extraction were performed by 2 authors independently; and STATA software was used for statistical analysis. The level of evidence was evaluated by applying the GRADE system.
Twelve RCTs involving 770 participants were enrolled. The results of the meta-analysis showed that probiotics could significantly reduce fasting blood glucose by -11.27mg/dL (95% CI -21.76 to -0.79; P<.001) and serum insulin concentration by -2.36μU/mL (95% CI -4.01 to -0.72; P=.005), but with no significant reduction on HbA (-0.19%; 95% CI -0.49 to 0.12; P=.23). Probiotics could significantly reduce HOMA-IR of T2DM patients (-1.05; 95% CI -1.52 to -0.59; P<.001). Nevertheless, the effect on QUICKI was negligible (0.00; 95% CI -0.00 to 0.01; P=.27). Results also confirmed the significant lowering effect of probiotics on total cholesterol (-8.49mg/dL; 95% CI -15.24 to -1.73; P=.014) and triglycerides (TG; -23.66mg/dL; 95% CI -40.26 to -7.05; P<.001), as well as the elevating effect on HDL-c (3.92mg/dL; 95% CI 2.14 to5.7; P<.01). However, there was no significant change on LDL-c (-0.84mg/dL; 95% CI -5.84 to 4.17; P=.75). Subgroup analysis was conducted for 2 outcomes, that is, serum insulin concentration and TG, whose heterogeneity was too high. The results showed multiple species of probiotics had stronger reduction effect on serum insulin concentration (-3.32μU/mL; 95% CI -5.89 to-0.75; P=.001) and TG (-25.94mg/dL; 95% CI -65.33 to 13.44; P<.001). In addition, it also suggested that only the duration of treatment for≥8 weeks could significantly reduce TG by -24.47mg/dL (95% CI -40.15 to -8.78; P=.001). The duration of treatment for<8 weeks didn't result in significant reduction on TG (-4.31mg/dL; 95% CI -37.69 to 29.06; P=.8). Finally, all the evidences were at moderate and low levels according to the GRADE system.
As a kind of the potential biotherapeutics in the management of T2DM, probiotics can improve glucose control and lipid metabolism.
客观评价补充益生菌对2型糖尿病（T2DM）患者血糖控制及脂质代谢的影响。
通过检索5个数据库自建库至2016年3月有关益生菌或合生元治疗T2DM的随机对照试验（RCT）。经研究筛选后，由2位作者独立进行质量评估和数据提取；并使用STATA软件进行统计分析。采用GRADE系统评估证据水平。
纳入12项RCT，共770例参与者。Meta分析结果显示，益生菌可使空腹血糖显著降低-11.27mg/dL（95%CI -21.76至-0.79；P<0.001），血清胰岛素浓度降低-2.36μU/mL（95%CI -4.01至-0.72；P=0.005），但对糖化血红蛋白（HbA）无显著降低作用（-0.19%；95%CI -0.49至0.12；P=0.23）。益生菌可显著降低T2DM患者的稳态模型评估胰岛素抵抗指数（HOMA-IR）（-1.05；95%CI -1.52至-0.59；P<0.001）。然而，对定量胰岛素敏感性检查指数（QUICKI）的影响可忽略不计（0.00；95%CI -0.00至0.01；P=0.27）。结果还证实益生菌对总胆固醇有显著降低作用（-8.49mg/dL；95%CI -15.24至-1.73；P=0.014），对甘油三酯（TG）也有显著降低作用（-23.66mg/dL；95%CI -40.26至-7.05；P<0.001），以及对高密度脂蛋白胆固醇（HDL-c）有升高作用（3.92mg/dL；95%CI 2.14至5.7；P<0.01）。然而，对低密度脂蛋白胆固醇（LDL-c）无显著变化（-0.84mg/dL；95%CI -5.84至4.17；P=0.75）。对血清胰岛素浓度和TG这2个异质性过高的结局进行亚组分析。结果显示多种益生菌对血清胰岛素浓度（-3.32μU/mL；95%CI -5.89至-0.75；P=0.001）和TG（-25.94mg/dL；95%CI -65.33至13.44；P<0.001）有更强降低作用。此外，还提示仅治疗持续时间≥8周可使TG显著降低-24.47mg/dL（95%CI -40.15至-8.78；P=0.001）。治疗持续时间<8周对TG无显著降低作用（-4.31mg/dL；95%CI -37.69至29.06；P=0.8）。最后，根据GRADE系统，所有证据均为中低水平。
作为T2DM管理中的一种潜在生物治疗方法，益生菌可改善血糖控制和脂质代谢。
