Probiotics: Reasonable Prevention for Diabetes?

Sometimes, a short, well-written summary of evidence is enough to illuminate an issue. Such is the case with an editorial titled, “Probiotic research for diabetes prevention,” published in the January 2015 issue of Nutrition.

Although the number of people diagnosed with diabetes globally is staggering—382 million individuals—experts indicate that number could increase to 592 million by 2035. The mortality figures are also staggering: every 6 seconds a person dies from diabetes. Every country in the world reports increasing numbers of people with type 2 diabetes mellitus (T2DM), with 80% of that population residing in the poorest of countries.

The authors note that unless patients have access to diabetes prevention programs (DPPs), we will meet or exceed expectations of widespread T2DM. DPPs tend to target people who have untreated prediabetes; these patients represent the highest risk population, with 11% of prediabetics developing full-blown diabetes annually. DPPs use many types of interventions including pharmacologic, lifestyle, and herbal remedies. They have also demonstrated that metformin therapy and intensive lifestyle intervention delay or prevent T2DM. More research is needed to determine if social, demographic and cultural difference affects prevention.

The authors focus on probiotics, which have been proven to improve insulin resistance, impaired insulin secretion, and metabolic defects associated with T2DM. They make several important points:

• Probiotics have few side effects compared to other drugs approved to treat T2DM.
• Probiotics target different pathologic mechanisms involved in glucose dysregulations than current pharmaceuticals do.
• Probiotics modulate host metabolism by affecting energy extraction from food and biochemically converting molecules derived from the host or from gut microbes themselves
• Modulating gut microbiota composition can regulate gut permeability, plasma endotoxin levels, fat gain, inflammation, and glucose tolerance. It can also improve glucose tolerance.

The authors review the increasing evidence of probiotics’ positive effects that may alleviate the development of metabolic disorders. They make the case for well-designed, controlled, sufficiently powered studies that will determine probiotics’ actual role in T2DM prevention.