Department of Internal Medicine, Faculty of Medicine, Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Faculdades Integradas de Taquara, Taquara, Brazil.
Diabetologia. 2021 Jan;64(1):26-41. doi: 10.1007/s00125-020-05295-1. Epub 2020 Oct 13.
AIMS/HYPOTHESIS: The aim was to conduct a systematic review and meta-analysis of randomised controlled clinical trials assessing the effect of probiotic, prebiotic or synbiotic supplementation on gut microbiota and glucose control and lipid levels in individuals with diabetes.
MEDLINE, EMBASE and the Cochrane Library were searched. The eligibility criteria for the studies was involvement of participants with a diagnosis of type 1 or type 2 diabetes. Metabolic outcomes (glucose control, insulinaemia, and lipid profile) of any probiotic, prebiotic or synbiotic supplementation related to modification of gut microbiota (prebiotics, probiotics and synbiotics) were analysed. We provided a narrative synthesis and meta-analysis of the findings on metabolic outcomes from the studies. Metabolic outcomes were extracted post-intervention and expressed as mean differences (MDs) and 95% CIs between treatment and comparator groups. We pooled the results using a random-effects meta-analysis. The meta-analysis was conducted using Review Manager (RevMan) software.
After the removal of duplicates and ineligible studies, 5219 studies were retained for review of titles and abstracts. The number of articles was reduced to 130 by review, for which the full-text articles were obtained and reassessed, 38 of which were included in the final meta-analysis. Overall, the use of prebiotics, probiotics or synbiotics reduced HbA levels, but did not reach the threshold for significance (-2.17 mmol/mol, 95% CI -4.37, 0.03; p = 0.05, [-0.20%, 95% CI -0.40 to 0.00; p = 0.05, I = 66%]) and had no effect on LDL-cholesterol levels (-0.05 mmol/l; 95% CI -0.14, 0.05, p = 0.35, I = 37%). However, their consumption decreased levels of fasting blood glucose (-0.58 mmol/l; 95% CI -0.86, -0.30; p < 0.01, I = 60%), total cholesterol (-0.14 mmol/l; 95% CI -0.26, -0.02, p = 0.02, I = 39%), triacylglycerols (-0.11 mmol/l; 95% CI -0.20, -0.02, p = 0.01, I= 21%) and insulinaemia (-10.51 pmol/l; 95% CI -16.68,-4.33, p < 0.01, I = 74%), and increased HDL-cholesterol levels (0.04 mmol/l; 95% CI 0.01, 0.07, p < 0.01, I= 24%).
CONCLUSIONS/INTERPRETATION: In individuals with diabetes mellitus, supplementation with probiotics, prebiotics or synbiotics improved metabolic variables, although the magnitude of this effect is low. Our results suggest that consumption of probiotics, prebiotics or synbiotics may be a potential adjuvant treatment for improving metabolic outcomes.
PROSPERO ID CRD42017080071. Graphical abstract.
目的/假设：本研究旨在对评估益生菌、益生元和合生元补充剂对糖尿病患者肠道微生物群和血糖控制及血脂水平影响的随机对照临床试验进行系统评价和荟萃分析。
检索 MEDLINE、EMBASE 和 Cochrane 图书馆。研究的纳入标准为纳入有 1 型或 2 型糖尿病诊断的参与者。分析了任何益生菌、益生元或合生元补充剂与肠道微生物群改变相关的代谢结局（血糖控制、胰岛素血症和血脂谱）。我们对来自研究的代谢结局进行了叙述性综合和荟萃分析。代谢结局在干预后提取，并表示为治疗组和对照组之间的均值差异（MDs）和 95%置信区间（CI）。我们使用随机效应荟萃分析对结果进行汇总。荟萃分析使用 Review Manager（RevMan）软件进行。
去除重复项和不合格研究后，保留了 5219 项研究进行标题和摘要的审查。通过审查，文章数量减少到 130 篇，获得并重新评估了这些文章的全文，并最终纳入了 38 项荟萃分析。总体而言，使用益生元、益生菌或合生元可降低 HbA 水平，但未达到显著水平（-2.17mmol/mol，95%CI-4.37，0.03；p=0.05，[-0.20%，95%CI-0.40 至 0.00；p=0.05，I=66%]），且对 LDL-胆固醇水平无影响（-0.05mmol/l；95%CI-0.14，0.05，p=0.35，I=37%）。然而，它们的消耗降低了空腹血糖水平（-0.58mmol/l；95%CI-0.86，-0.30；p<0.01，I=60%）、总胆固醇水平（-0.14mmol/l；95%CI-0.26，-0.02，p=0.02，I=39%）、三酰甘油水平（-0.11mmol/l；95%CI-0.20，-0.02，p=0.01，I=21%）和胰岛素血症（-10.51pmol/l；95%CI-16.68，-4.33，p<0.01，I=74%），并增加了 HDL-胆固醇水平（0.04mmol/l；95%CI 0.01，0.07，p<0.01，I=24%）。
结论/解释：在糖尿病患者中，益生菌、益生元和合生元补充剂可改善代谢变量，尽管这种效果的幅度较小。我们的研究结果表明，益生菌、益生元和合生元的消耗可能是改善代谢结果的一种潜在辅助治疗方法。
PROSPERO ID CRD42017080071. 图表摘要。
