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Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Sep 15, 2021; 12(9): 1463-1478
Published online Sep 15, 2021. doi: 10.4239/wjd.v12.i9.1463
Holistic perspective of the role of gut microbes in diabetes mellitus and its management
Kannayiram Alagiakrishnan, Tyler Halverson
Kannayiram Alagiakrishnan, Tyler Halverson, Department of Medicine, University of Alberta, Edmonton T6G 2G3, Alberta, Canada
Author contributions: Alagiakrishnan K and Halverson T contributed equally by reviewing the literature and drafting the manuscript; both the authors have read and approved the final version.
Conflict-of-interest statement: The authors declare no potential conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kannayiram Alagiakrishnan, FRCPC, MD, Full Professor, Medicine, University of Alberta, B139-152 University Hospital Clinical Sciences Building, Edmonton T6G 2G3, Alberta, Canada. kalagiakri@aol.com
Received: February 26, 2021
Peer-review started: February 26, 2021
First decision: April 20, 2021
Revised: April 24, 2021
Accepted: August 13, 2021
Article in press: August 13, 2021
Published online: September 15, 2021
Processing time: 192 Days and 15.5 Hours
Abstract

The gut microbiota (GM) plays a role in the development and progression of type 1 and type 2 diabetes mellitus (DM) and its complications. Gut dysbiosis contributes to the pathogenesis of DM. The GM has been shown to influence the efficacy of different antidiabetic medications. Intake of gut biotics, like prebiotics, probiotics and synbiotics, can improve the glucose control as well as the metabolic profile associated with DM. There is some preliminary evidence that it might even help with the cardiovascular, ophthalmic, nervous, and renal complications of DM and even contribute to the prevention of DM. More large-scale research studies are needed before wide spread use of gut biotics in clinical practice as an adjuvant therapy to the current management of DM.

Keywords: Probiotics; Prebiotics; Synbiotics; Diabetes mellitus; Microbial dysbiosis; Antidiabetic drugs

Core Tip: The emerging role of the gut microbiome on diabetes development, progression as well as prevention has been discussed in this manuscript. The significance of gut dysbiosis in the aetiopathogenesis of diabetes mellitus and its complications has been reviewed. A bidirectional relationship exists between the antidiabetic drugs and the gut microbiome. Faecal transplantation, and bariatric surgery, typically used to treat morbid obesity, have also been shown to improve commensal gut microbiota changes. Diabetic outcomes and management can improve with better understanding of the drug-gut microbiome interactions. There is emerging evidence pointing out that gut biotics can be an add-on therapy with the antidiabetic management. To our knowledge, there is no evidence about the role of gut microbes of diabetic patients who had pancreatic cell transplantation, as well as the role of gut biotics influencing the management in this group.