不同干预时间的益生菌对2型糖尿病患者血糖控制的影响：一项系统评价和荟萃分析
Effect of probiotics at different intervention time on glycemic control in patients with type 2 diabetes mellitus: a systematic review and meta-analysis.
作者信息
Wang Xinghui, Chen Lu, Zhang Chunling, Shi Qing, Zhu Lei, Zhao Sisi, Luo Zhiqin, Long Yirun
机构信息
School of Nursing, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China.
Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China.
出版信息
Front Endocrinol (Lausanne). 2024 Jul 24;15:1392306. doi: 10.3389/fendo.2024.1392306. eCollection 2024.
BACKGROUND
Type 2 diabetes mellitus(T2DM) is characterized by hyperglycemia. Gut microbiome adjustment plays a positive part in glucose regulation, which has become a hotspot. Probiotics have been studied for their potential to control the gut flora and to treat T2DM. However, the conclusion of its glucose-lowering effect is inconsistent based on different probiotic intervention times.
OBJECTIVES
To comprehensively evaluate how various probiotic intervention times affect glycemic control in people with T2DM.
METHODS
We retrieved PubMed, Embase, Web of Science, and Cochrane Library on randomized controlled trials(RCTs)regarding the impact of probiotics on glycemic control in patients with T2DM from the inception to November 16, 2023. Separately, two researchers conducted a literature analysis, data extraction, and bias risk assessment of the involved studies. We followed the PRISMA guidelines, used RevMan 5.4 software for meta-analysis, and assessed the risk of bias by applying the Cochrane Handbook for Systematic Reviews 5.1.0.
RESULTS
We included eight RCTs with 507 patients. Meta-analysis revealed that the use of probiotics might considerably reduce levels of glycosylated hemoglobin (HbA1c) {mean deviation (MD) = -0.33, 95% confidence interval (CI) (-0.59, -0.07), p = 0.01}, Insulin {standard mean deviation (SMD) = -0.48, 95% CI (-0.74, -0.22), p = 0.0003} and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR){SMD = -1.36, 95% CI (-2.30, -0.41), p = 0.005} than placebo group. No statistically significant differences were found regarding fasting blood glucose (FBG) and body mass index (BMI) {SMD = -0.39, 95% CI (-0.83, 0.05), p = 0.08}, {SMD = -0.40, 95% CI (-1.07, 0.27), p = 0.25}, respectively. Subgroup analyses, grouped by intervention times, showed that six to eight weeks of intervention improved HbA1c compared to the control group (p < 0.05), both six to eight weeks and 12-24 weeks had a better intervention effect on Insulin, and HOMA-IR (p < 0.05).In contrast, there was no statistically significant variation in the length between FBG and BMI regarding duration.
CONCLUSION
This meta-analysis found probiotics at different intervention times play a positive role in modulating glucose in T2DM, specifically for HbA1c in six to eight weeks, Insulin and HOMA-IR in six to eight weeks, and 12-24 weeks. To confirm our findings, further excellent large-sample research is still required.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero, identifier CRD42023483325.
背景
2型糖尿病（T2DM）的特征是血糖升高。肠道微生物群调节在血糖调节中发挥着积极作用，这已成为一个研究热点。益生菌因其控制肠道菌群和治疗T2DM的潜力而受到研究。然而，基于不同的益生菌干预时间，其降糖效果的结论并不一致。
目的
全面评估不同的益生菌干预时间如何影响T2DM患者的血糖控制。
方法
我们检索了PubMed、Embase、Web of Science和Cochrane图书馆，以获取从数据库建立至2023年11月16日关于益生菌对T2DM患者血糖控制影响的随机对照试验（RCT）。另外，两名研究人员对纳入研究进行文献分析、数据提取和偏倚风险评估。我们遵循PRISMA指南，使用RevMan 5.4软件进行荟萃分析，并根据《Cochrane系统评价手册5.1.0》评估偏倚风险。
结果
我们纳入了8项RCT，共507例患者。荟萃分析显示，与安慰剂组相比，使用益生菌可能会显著降低糖化血红蛋白（HbA1c）水平{平均差（MD）=-0.33，95%置信区间（CI）（-0.59，-0.07），p=0.01}、胰岛素水平{标准化均数差（SMD）=-0.48，95%CI（-0.74，-0.22），p=0.0003}和胰岛素抵抗稳态模型评估（HOMA-IR）{SMD=-1.36，95%CI（-2.30，-0.41），p=0.005}。在空腹血糖（FBG）和体重指数（BMI）方面未发现统计学显著差异{SMD=-0.39，95%CI（-0.83，0.05），p=0.08}，{SMD=-0.40，95%CI（-1.07，0.27），p=0.25}。按干预时间分组的亚组分析表明，与对照组相比，6至8周的干预可改善HbA1c（p<0.0
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