August 23, 2018
2 min read

Probiotic supplementation may confer cardiometabolic benefits in type 2 diabetes

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Shaun Sabico 2018
Shaun Sabico

Adults with newly diagnosed type 2 diabetes randomly assigned to twice-daily, multi-strain probiotic therapy for 6 months experienced improvements in insulin resistance and endotoxin-induced inflammation vs. those assigned to placebo for the same period, according to findings published in Clinical Nutrition.

“People with diabetes have altered gut microbiota,” Shaun Sabico, MD, PhD, the Prince Mutaib Bin Abdullah chair on osteoporosis at King Saud University College of Science in Riyadh, Saudi Arabia, told Endocrine Today. "Manipulation of the gut microbiome through multi-strain probiotic supplementation can improve insulin sensitivity.”

In a single-center, double-blind, randomized placebo-controlled study, Sabico and colleagues analyzed data from 61 adults (26 men) aged 30 to 60 years with newly diagnosed type 2 diabetes recruited between January 2014 and February 2016. All participants were patients who visited the outpatient department of King Salman Hospital in Riyadh and did not have diabetes complications. Researchers randomly assigned participants to 2 g sachets of freeze-dried probiotic powder (Ecologic Barrier, Winclove Probiotics), including eight probiotic strains (n = 31; mean age, 48 years; mean BMI, 29.4 kg/m²), or placebo sachets containing 2 g freeze-dried maize starch and maltodextrins (n = 30; mean age, 47 years; mean BMI, 30.1 kg/m²). Researchers asked all participants to consume their assigned treatment twice daily before breakfast and bedtime. Height, weight, blood pressure, waist and hip measurements, BMI and waist-to-hip ratio were measured at baseline, 3 and 6 months, and all participants provided fasting blood samples to measure glucose and lipid profile. Insulin resistance was measured via homeostatic model assessment of insulin resistance. Primary outcome was circulating endotoxin level; secondary outcomes included glycemic parameters, lipid profile, inflammatory and adipocytokine markers. Researchers used mixed-method analysis of covariance to determine within and between-group differences at 3 and 6 months.

Researchers observed percent change differences in HOMA-IR favoring the probiotics group at both 3 months (0% vs. –60.4%) and 6 months (20.5% vs. –64.2%). Between-group comparisons showed no differences for levels of tumor necrosis factor-alpha, interleukin-6 and C-reactive protein, but within-group comparisons showed all inflammatory markers improved over time in the probiotics group, according to the researchers. Similarly, there were no between-group differences observed for lipid markers, but researchers observed improvements in triglyceride levels, total cholesterol and HDL cholesterol in the probiotics group.

In within-group comparisons, researchers also observed a mean –58.1% decrease in resistin levels between baseline and 6 months for the probiotic group (P < .05) as well as a mean 38.1% increase in endotoxin levels at 6 months vs. 3 months in the placebo group. In the probiotics group, researchers observed an improvement in endotoxin levels (mean decrease at 6 months, –69.6%) and adiponectin levels (mean increase at 6 months, 71.8%). There were no changes in leptin levels for either group.

“Our study is, to our knowledge, the first to demonstrate the effects of a multi-strain probiotic supplement given over 6 months in the Arab [type 2 diabetes] population, using endotoxin as the primary endpoint,” the researchers wrote. “It is also important to stress that the probiotic supplementation in this present study was used as a standalone treatment given in the absence of exercise and diet-related modifications in the intervention or lifestyle control in a culture with easy access to food.”

The researchers noted that the sample size for the study was small and that members of the probiotics group were less metabolically healthy vs. the placebo group before randomization.

“Multi-strain probiotic supplementation can be beneficial for the prevention of diabetes and as an adjuvant therapy for people with diabetes thereby reducing healthcare costs,” Sabico said.– by Regina Schaffer

For more information:

Shaun Sabico, MD, PhD, can be reached at Warwick Medical School, University of Warwick, Clinical Sciences Building, Clifford Bridge Road, Coventry, CV2 2DX, UK; email:

Disclosures: The authors report no relevant financial disclosures.