益生菌对成人 2 型糖尿病影响的随机对照试验的荟萃分析。
Meta-analysis of randomized controlled trials of the effects of probiotics on type 2 diabetes in adults.
机构信息
State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, 214122, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, 214122, China.
State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, 214122, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, 214122, China; College of Food Science and Light Industry, Nanjing Tech University, Nanjing, 211816, China.
出版信息
Clin Nutr. 2022 Feb;41(2):365-373. doi: 10.1016/j.clnu.2021.11.037. Epub 2021 Dec 10.
BACKGROUND & AIMS: Despite advancements in preventive medicine and pharmacotherapy, diabetes remains an overwhelming health problem. Evidence from randomized controlled trials (RCTs) suggests that probiotics may offer beneficial effects on glycemic control. Our objective was to perform a systematic review and meta-analysis of RCTs to quantify the effect of probiotic administration on glycemic homeostasis in type 2 diabetes.
METHODS
Medline, Web of Science, Google Scholar, and Cochrane Central Register of Controlled Trials were searched for relevant trials published until October 12, 2021. RCTs that lasted ≥3 weeks and assessed the effects of probiotics on the markers of glycemic homeostasis in type 2 diabetes were included. Data were pooled using the generic inverse variance method and expressed as mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using Cochran's Q statistic and quantified using the I statistic. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the certainty of evidence.
RESULTS
A total of 33 eligible trial comparisons (n = 1927) were included in this meta-analysis. Our results revealed that compared with placebo, a median probiotic dose of ∼10 cfu/day significantly reduced the glycated hemoglobin (HbA) levels (MD: -0.19% [95% CI: -0.32, -0.07]; P = 0.003), fasting blood glucose levels (MD: -1.00 mmol/L [95% CI: -1.45, -0.56]; P < 0.0001), fasting insulin levels (MD: -5.73 pmol/L [95% CI: -12.17, 0.72]; P = 0.08), and HOMA-insulin resistance (IR) (MD: -1.00 [95% CI: -1.32, -0.68]; P < 0.00001). The certainty of evidence was graded low for HbA and fasting glucose, moderate for fasting insulin, and high for HOMA-IR. Probiotic supplements do not induce clinically significant reductions in HbA levels, but lead to marginally clinically significant reductions in fasting glucose and fasting insulin levels in patients with type 2 diabetes. Compared with single-strain and low-dose probiotics, multi-strain and high-dose probiotics have a greater beneficial effect on glycemic homeostasis. In addition, probiotic treatment may be more effective in patients with a high baseline body mass index and age.
背景与目的
尽管预防医学和药物治疗取得了进展，但糖尿病仍然是一个严重的健康问题。随机对照试验（RCT）的证据表明，益生菌可能对血糖控制有有益的影响。我们的目的是进行系统评价和荟萃分析，以量化益生菌给药对 2 型糖尿病患者血糖稳态的影响。
方法
检索 Medline、Web of Science、Google Scholar 和 Cochrane 对照试验中心注册库，检索截至 2021 年 10 月 12 日发表的相关试验。纳入持续时间≥3 周且评估益生菌对 2 型糖尿病患者血糖稳态标志物影响的 RCT。使用通用倒数方差法汇总数据，并以均数差值（MDs）和 95%置信区间（CIs）表示。使用 Cochran's Q 统计量评估异质性，并使用 I 统计量进行量化。使用推荐评估、制定与评价（GRADE）方法评估证据的确定性。
结果
本荟萃分析共纳入 33 项符合条件的试验比较（n=1927）。我们的结果表明，与安慰剂相比，中位数益生菌剂量约为 10cfu/天，显著降低糖化血红蛋白（HbA）水平（MD：-0.19%[95%CI：-0.32，-0.07]；P=0.003）、空腹血糖水平（MD：-1.00mmol/L[95%CI：-1.45，-0.56]；P<0.0001）、空腹胰岛素水平（MD：-5.73pmol/L[95%CI：-12.17，0.72]；P=0.08）和 HOMA-胰岛素抵抗（IR）（MD：-1.00[95%CI：-1.32，-0.68]；P<0.00001）。HbA 和空腹血糖的证据确定性等级为低，空腹胰岛素的证据确定性等级为中，HOMA-IR 的证据确定性等级为高。益生菌补充剂不会导致 HbA 水平显著降低，但会使 2 型糖尿病患者的空腹血糖和空腹胰岛素水平略有显著降低。与单菌株和低剂量益生菌相比，多菌株和高剂量益生菌对血糖稳态有更大的有益影响。此外，益生菌治疗在基线体重指数和年龄较高的患者中可能更有效。
Zotero 插件