Gut microbiota interactions with anti-diabetic medications and pathogenesis of type 2 diabetes mellitus

Table 1 Impact of anti-diabetic medications on the gut microbiota

Drug	Changes in microbiota
Metformin	Increase in SCFA producing bacteria[5,30], Akkermansia muciniphila[29,30,46], Firmicutes[5] and Proteobacteria[5]; Increased fecal concentrations of lactate and succinate[5]; Decreased concentration of TMAO and its precursor metabolites[44]
Liraglutide	Increase in Bacteroidetes to Firmicutes ratio[49] and Akkermansia[50]; Increase in lean related phenotypes (Blautia and Coprococcus)[49]; Decrease in Obese related phenotypes (Romboutsia, Ruminiclostridium and Erysipelotrichaceae)[49]
Dulaglutide	Increase in Bacteroidetes to Firmicutes ratio[51]
Sitagliptin	Increase in Bacteroidetes to Firmicutes ratio[7]; Increase in SCFAs and other organic acids like succinate[54]
Saxagliptin	No change in Bacteroidetes to Firmicutes ratio[49]; Obesity related phylotype= Decrease in only one genus Candidatus Arthromitus[49]; Lean related phenotype= Increase in the family Lactobacillaceae but Decrease in genus Balutia and Coprococcus[49]
Vildagliptin	Increase in lactobacillus species and propionate[8]; Decrease in Oscillibacter species[8]
Linagliptin	Increase in Bacteroidetes and decrease in Protobacteria species[8]
Empagliflozin	Increase in Bacteroidetes to Firmicutes ratio[51]
Dapagliflozin	Increase in Bacteroidetes to Firmicutes ratio[9]; Increased Oscillospira and Akkermansia muciniphila species[9]
Canagliflozin	Increase in Bacteroidetes to Firmicutes ratio[57]; Increase in Olsenella[57], Alistipes[57], Alloprevotella[57] and Lactobacillus species[58]; Decrease in Helicobacter and Mucispirillum species[57]
PPARγ agonists	Firmicutes and Fusobacteria stimulate PPAR gamma activity[63]
Acarbose	Increase in Lactobacillus and Dialister genera[66]; Decrease in Butyricicoccus, Phascolarctobacterium, and Ruminococcus genera[66]; Increase in the ratio between primary bile acids and secondary bile acids[70]
Sulfonylureas	Glicazide have not shown any significant differences on gut microbiome in diabetic patients after 12 wk of intervention[68]

SCFA: Short chain fatty acid; TMAO: Trimethylamine N-oxide.