Mindrescu Nicoleta Mihaela, Guja Cristian, Jinga Viorel, Ispas Sorina, Curici Antoanela, Danciulescu Miulescu Rucsandra Elena, Nelson Twakor Andreea, Pantea Stoian Anca Mihaela
Faculty of Medicine and Pharmacy, "Carol Davila" University, 050474 Bucharest, Romania.
National Institute of Diabetes "NC Paulescu", 030167 Bucharest, Romania.
Metabolites. 2025 Jun 18;15(6):411. doi: 10.3390/metabo15060411.
The gut microbiota plays a critical role in metabolic health and type 2 diabetes mellitus (T2DM). Alterations in microbial composition may influence glycemic control and systemic inflammation.
In this single-center, randomized study, 60 adults with T2DM receiving metformin were evaluated biologically and received either empagliflozin or sitagliptin. Demographic, metabolic, and lifestyle data were collected. Gut microbiota profiling was conducted at two timepoints to assess changes in bacterial and fungal taxa. Blood glucose, HbA1c, and inflammation markers were analyzed longitudinally.
Both treatment groups showed significant improvements in glycemic control. Median fasting glucose decreased from 132 to 123 mg/dL ( = 0.046) in the sitagliptin group and from 131 to 114 mg/dL ( = 0.025) in the empagliflozin group. Median HbA1c levels declined significantly in both groups, with a greater reduction in the empagliflozin group ( = 0.001 vs. = 0.049). The microbiota analysis revealed an increase in beneficial bacteria (e.g., spp. and spp.) and a decrease in pro-inflammatory taxa and spp.). Notably, empagliflozin was associated with a more pronounced microbiota rebalancing and a significant decline in fungal overgrowth (e.g., spp.; = 0.034).
Treatment with sitagliptin and empagliflozin led to improved glycemic outcomes and partial restoration of gut microbial balance in T2DM patients. Empagliflozin showed superior efficacy in modulating both glycemia and dysbiosis.
肠道微生物群在代谢健康和2型糖尿病（T2DM）中起关键作用。微生物组成的改变可能会影响血糖控制和全身炎症。
在这项单中心随机研究中，对60名接受二甲双胍治疗的T2DM成年患者进行生物学评估，并给予恩格列净或西格列汀治疗。收集人口统计学、代谢和生活方式数据。在两个时间点进行肠道微生物群分析，以评估细菌和真菌类群的变化。纵向分析血糖、糖化血红蛋白（HbA1c）和炎症标志物。
两个治疗组的血糖控制均有显著改善。西格列汀组空腹血糖中位数从132mg/dL降至123mg/dL（P = 0.046），恩格列净组从131mg/dL降至114mg/dL（P = 0.025）。两组HbA1c中位数水平均显著下降，恩格列净组下降幅度更大（P = 0.001对P = 0.049）。微生物群分析显示有益菌（如双歧杆菌属和阿克曼氏菌属）增加，促炎类群（如普氏菌属和瘤胃球菌属）减少。值得注意的是，恩格列净与更明显的微生物群重新平衡和真菌过度生长的显著下降有关（如白色念珠菌属；P = 0.034）。
西格列汀和恩格列净治疗可改善T2DM患者的血糖结局并部分恢复肠道微生物平衡。恩格列净在调节血糖和肠道菌群失调方面显示出卓越疗效。
