The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia.
Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia.
Nutrients. 2020 Jul 9;12(7):2041. doi: 10.3390/nu12072041.
Early treatment may prevent or delay the onset of type 2 diabetes mellitus (T2DM) in individuals who are at high risk. Lifestyle interventions and the hypoglycemic drug metformin have been shown to reduce T2DM incidence. The effectiveness of such interventions may be enhanced by targeting environmental factors such as the intestinal microbiota, which has been proven to predict the response to lifestyle interventions and play a part in mediating the glucose-lowering effects of metformin. Shifts in the intestinal microbiota "towards a more balanced state" may promote glucose homeostasis by regulating short-chain fatty acids' production. This study aimed to investigate the safety and effect of a multi-strain probiotic on glycemic, inflammatory, and permeability markers in adults with prediabetes and early T2DM and to assess whether the probiotic can enhance metformin's effect on glycaemia. A randomised controlled pilot study was conducted in 60 adults with a BMI ≥ 25 kg/m and with prediabetes or T2DM (within the previous 12 months). The participants were randomised to a multi-strain probiotic (, , , , , , , and ) or placebo for 12 weeks. Analyses of the primary outcome (fasting plasma glucose) and secondary outcomes, including, but not limited to, circulating lipopolysaccharide, zonulin, and short chain fatty acids and a metagenomic analysis of the fecal microbiome were performed at baseline and 12 weeks post-intervention. The results showed no significant differences in the primary and secondary outcome measures between the probiotic and placebo group. An analysis of a subgroup of participants taking metformin showed a decrease in fasting plasma glucose, HbA1c, insulin resistance, and zonulin; an increase in plasma butyrate concentrations; and an enrichment of microbial butyrate-producing pathways in the probiotic group but not in the placebo group. Probiotics may act as an adjunctive to metformin by increasing the production of butyrate, which may consequently enhance glucose management.
早期治疗可能预防或延迟高危人群 2 型糖尿病（T2DM）的发生。生活方式干预和降糖药物二甲双胍已被证明可降低 T2DM 的发病率。通过针对环境因素（如肠道微生物群）进行靶向干预，可以增强这些干预措施的效果，肠道微生物群已被证明可以预测生活方式干预的反应，并在介导二甲双胍的降血糖作用中发挥作用。肠道微生物群向“更平衡的状态”的转变可能通过调节短链脂肪酸的产生来促进血糖稳态。本研究旨在调查多菌株益生菌对糖尿病前期和早期 T2DM 成人血糖、炎症和通透性标志物的安全性和影响，并评估益生菌是否可以增强二甲双胍对血糖的作用。一项随机对照试验在 60 名 BMI≥25kg/m 且患有糖尿病前期或 T2DM（在过去 12 个月内）的成年人中进行。参与者被随机分配到多菌株益生菌（，，，，，，和）或安慰剂组，持续 12 周。在基线和干预后 12 周时，对主要结局（空腹血糖）和次要结局（包括但不限于循环脂多糖、肠紧密连接蛋白和短链脂肪酸）进行分析，并对粪便微生物组进行宏基因组分析。结果显示，益生菌组和安慰剂组在主要和次要结局测量上无显著差异。对服用二甲双胍的参与者亚组的分析显示，空腹血糖、HbA1c、胰岛素抵抗和肠紧密连接蛋白降低，血浆丁酸盐浓度升高，而益生菌组中丁酸产生途径的微生物丰度增加，但安慰剂组没有。益生菌可能通过增加丁酸的产生来作为二甲双胍的辅助治疗，从而改善血糖管理。
