The Role of Gut Microbiota in Type 2 Diabetes and its Complications
Dive into the science of gut bacteria and their impact on Type 2 diabetes. Discover key risk factors, the role of dysbiosis, and natural strategies like probiotics & diet to support gut health and potentially manage diabetes.
DR T S DIDWAL MD
12/22/20236 min read
Type 2 diabetes is a global health concern, with millions of people affected by this metabolic disorder. As the prevalence of diabetes continues to rise, researchers are delving deeper into the factors contributing to its development and the associated complications. One emerging area of interest is the gut microbiota and its intricate relationship with type 2 diabetes. In this comprehensive article published in Nutrients, we explore the multifaceted role of the gut microbiota in the context of type 2 diabetes and its complications.
Key Points
Type 2 Diabetes (T2D) Overview:
T2D is the fastest-growing metabolic disease globally, affecting over 422 million people.
Risk factors include genetics, lifestyle, diet, aging, and epigenetics.
T2D is characterized by hyperglycemia, insulin resistance, and chronic inflammation.
Role of Gut Microbiota:
T2D patients exhibit metabolic disorders and chronic inflammation linked to disturbances in the gut microbiota.
Gut microbiota, with over 10 times the number of human cells, influences body metabolism and immune regulation.
Dysbiosis in the gut microbiota leads to disturbances in insulin sensitivity, glucose metabolism, and immune homeostasis.
Structural Characteristics of Gut Microbiota in T2D:
Studies show the enrichment of conditioned pathogens like Escherichia coli, Clostridium species, Bacteroides caccae, and Eggerthella lenta in T2D patients.
Butyrate-producing bacteria, beneficial for health, are reduced in abundance.
Intestinal Barrier Disruption:
The intestinal barrier, comprising mucus, epithelial cells, and vascular barriers, prevents the invasion of pathogenic bacteria.
Dysbiosis in T2D contributes to the disruption of the intestinal barrier.
Gut Microbiota Metabolites and Effects:
Metabolites of the gut microbiota, such as imidazole propionate (ImP), impact insulin signaling.
These metabolites can enter the circulatory system, affecting remote organs like the liver, kidneys, and cardiovascular system.
Role of Diet:
Intermittent fasting shows promise in countering or improving metabolic diseases, including T2D.
Health benefits may be linked to improvements in the gut microbiota composition.
Conclusion and Future Prospects:
The gut microbiota is a key regulator of body metabolism and plays a significant role in T2D.
Imbalances in intestinal bacteria and disruption of the intestinal protective barrier contribute to T2D.
Understanding the Gut Microbiota
Before delving into the connection between the gut microbiota and Type 2 diabetes, it's crucial to grasp the complexity of the gut microbiota itself. Our gastrointestinal tract is home to trillions of microorganisms, primarily bacteria but also including archaea, viruses, fungi, and protists. This diverse community forms the gut microbiota, and its composition can vary significantly from one individual to another. The balance and diversity of these microorganisms are essential for maintaining overall health. Dysbiosis, a term used to describe an imbalance or disruption in the gut microbiota, can have far-reaching consequences for our well-being. Dysbiosis often results from a decrease in the diversity and abundance of specific bacteria and fungi, particularly those associated with various pathologies.
Gut Microbiota and Type 2 Diabetes
Type 2 diabetes is a chronic metabolic disorder characterized by elevated blood sugar levels. It can occur due to decreased pancreatic insulin production or reduced insulin sensitivity in target tissues. While genetic and lifestyle factors play significant roles in the development of type 2 diabetes, emerging research highlights the contribution of the gut microbiota to this condition. Studies have shown a compelling link between alterations in the composition of the gut microbiota and the risk of developing type 2 diabetes. Particularly, the imbalance between the Bacteroidetes and Firmicutes phyla has drawn attention. An increase in Firmicutes and a decrease in Bacteroidetes have been associated with a higher risk of insulin resistance and impaired glucose metabolism. The mechanisms underlying this relationship are intricate. One key aspect is the role of the gut barrier. An imbalanced gut microbiota can lead to increased intestinal permeability, often referred to as a "leaky gut." This heightened permeability allows bacterial byproducts to enter the bloodstream, triggering inflammatory responses that are characteristic of diabetes.
On the flip side, specific strains of bacteria have been found to exert protective effects against the development of type 2 diabetes. These beneficial bacteria, such as Lactobacillus fermentum, Lactobacillus plantarum, Lactobacillus casei, Roseburia intestinalis, Akkermansia muciniphila, and Bacteroides fragilis, have demonstrated the ability to reduce proinflammatory markers and maintain the integrity of the intestinal barrier. Consequently, they improve glucose metabolism and insulin sensitivity. Furthermore, some medications used to manage diabetes, such as metformin, have been shown to influence the gut microbiota. Metformin interacts with the gut microbiota by modulating inflammation, enhancing glucose homeostasis, improving gut barrier function, and promoting the growth of bacteria that produce beneficial short-chain fatty acids. This interaction may contribute to the positive effects of metformin on glucose metabolism in individuals with type 2 diabetes.
Gut Microbiota Dysbiosis and Diabetes Complications
While much attention has been given to the role of the gut microbiota in the development of type 2 diabetes, emerging evidence suggests that dysbiosis of the gut microbiota is not limited to diabetes itself but extends to its complications. Researchers have observed differences in the composition of the gut microbiota in individuals with Type 2 diabetes who also experience complications, such as diabetic nephropathy, diabetic retinopathy, diabetic neuropathy, cerebrovascular disease, coronary heart disease, and peripheral artery disease, compared to those without these complications.
Remarkably, the severity of gut microbiota dysbiosis appears to be correlated with the severity of these complications. Studies conducted in both animal models and human patients have demonstrated that restoring gut microbiota balance through interventions like probiotic administration can lead to improvements in symptoms and disease progression. This suggests that the gut microbiota could be a crucial factor influencing not only the onset but also the course of diabetes complications. The gut microbiota and diabetes complications
Diabetes and its complications
Diabetes is a chronic disease that affects how the body regulates blood sugar levels. People with diabetes either do not produce enough insulin or their cells do not respond properly to insulin. This can lead to high blood sugar levels, which can damage organs and tissues throughout the body. Diabetes complications can affect many parts of the body, including the eyes, kidneys, nerves, and heart. Some of the most common diabetes complications include:
Diabetic retinopathy: damage to the blood vessels in the eyes, which can lead to vision loss or blindness
Diabetic nephropathy: damage to the kidneys, which can lead to kidney failure
Diabetic neuropathy: damage to the nerves, which can cause pain, numbness, and tingling
Diabetic foot ulcers: open sores on the feet that can be slow to heal and can lead to infection
Heart disease: diabetes is a major risk factor for heart disease, stroke, and peripheral arterial disease
The role of the gut microbiota in diabetes complications
The gut microbiota is thought to play a role in the development of diabetes and its complications in several ways. For example, the gut microbiota can influence how the body absorbs nutrients, how it stores fat, and how it responds to inflammation. Several studies have shown that people with diabetes have a different gut microbiota composition than people without diabetes. These differences in gut microbiota composition may be due to changes in diet, medications, or other factors. Some studies have also shown that changes in the gut microbiota can lead to the development of diabetes complications. For example, one study showed that mice with a specific type of gut bacteria were more likely to develop diabetic nephropathy than mice without that type of bacteria.
Potential therapeutic interventions
There is growing interest in the potential of using probiotics, prebiotics, or synbiotics to treat or prevent diabetes and its complications. Probiotics are live bacteria that can be taken in supplement form or that are found in some foods, such as yogurt. Prebiotics are non-digestible fibers that can help promote the growth of beneficial bacteria in the gut. Synbiotics are a combination of probiotics and prebiotics. Several studies have shown that probiotics, prebiotics, or synbiotics may be beneficial for people with diabetes. For example, one study showed that taking a probiotic supplement improved blood sugar control in people with type 2 diabetes. Another study showed that taking a prebiotic supplement reduced the risk of developing diabetic nephropathy in mice.
Key points
Gut microbiota imbalance (dysbiosis) is linked to diabetes and its complications, like nephropathy, neuropathy, retinopathy, and cardiovascular issues.
Dysbiosis affects how the body absorbs nutrients, stores fat, and responds to inflammation, worsening diabetes and its complications.
Diabetic complications are caused by high blood sugar and involve kidney damage, nerve damage, vision problems, and increased heart disease risk.
The gut microbiota composition differs between people with and without diabetes, suggesting a potential role in disease development.
Studies hint at using probiotics, prebiotics, and synbiotics to modulate the gut microbiota and potentially manage diabetes complications.
More research is needed to establish a causal link and develop personalized therapeutic interventions targeting the gut microbiota for efficient diabetes management.
Conclusion
The gut microbiota is a complex community of microorganisms that plays an important role in human health and disease. The gut microbiota is thought to play a role in the development of diabetes and its complications. There is growing interest in the potential of using probiotics, prebiotics, or synbiotics to treat or prevent diabetes and its complications. More research is needed to determine whether these interventions are effective in humans.
References
Iatcu, C. O., Steen, A., & Covasa, M. (2021). Gut Microbiota and Complications of Type-2 Diabetes. Nutrients, 14(1), 166. https://doi.org/10.3390/nu14010166
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