Impact of the gut microbiota on the pathogenesis and therapeutics of diabetes mellitus
DOI:
https://doi.org/10.47196/diab.v60i1.1290Keywords:
gut microbiota, type 1 and 2 diabetes, low-grade inflammation, short-chain fatty acids, tryptophan, probiotics, prebioticsAbstract
The gut microbiota has emerged as a key player in the pathophysiology of metabolic diseases. In this review, our aim is to specifically address its relationship with the pathogenesis and therapeutic approaches of diabetes mellitus. In type 2 diabetes, gut dysbiosis is linked to chronic low-grade inflammation, insulin resistance, and the progression of cardiometabolic complications. In type 1 diabetes, growing evidence suggests that the gut microbiota may contribute to the breakdown of immune tolerance and to autoimmune progression.
The production of bioactive metabolites, such as short-chain fatty acids, tryptophan derivatives, and bile acids metabolites, mediates the connection between the microbiota and energy metabolism. Moreover, the gut microbiota influences the pharmacodynamics and pharmacokinetics of antidiabetic agents such as metformin, highlighting its potential as a biomarker of therapeutic response.
The translation of experimental findings into practice is still in its early stages. Nonetheless, practical strategies to modulate the gut microbiota are emerging, including increased dietary fiber intake, consumption of fermented foods and prebiotics, and regular physical activity, all of which enhance microbial diversity and the production of beneficial metabolites. Probiotics have shown encouraging results in both type 1 and type 2 diabetes, although their systematic incorporation into clinical guidelines has yet to be established.
Integrating knowledge of the gut microbiota may drive the development of novel diagnostic and therapeutic tools capable of transforming diabetes care. The key challenge ahead is to advance with robust clinical studies that can translate these insights into personalized and effective interventions for people living with diabetes.
For this narrative review, the literature was retrieved through non-structured searches of international databases, including PubMed, using combinations of terms such as “gut microbiota,” “metabolic diseases,” “low-grade inflammation,” “type 1 diabetes,” “type 2 diabetes,” and “insulin resistance,” among others. Original articles and review papers published in international specialty journals were prioritized, with particular emphasis on conceptual and experimental advances from the past 5–10 years.
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