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European Journal of Nutrition
Published in: European Journal of Nutrition 4/2017

01-06-2017 | Original Contribution

Effect of multi-strain probiotics (multi-strain microbial cell preparation) on glycemic control and other diabetes-related outcomes in people with type 2 diabetes: a randomized controlled trial

Authors: Somayyeh Firouzi, Hazreen Abdul Majid, Amin Ismail, Nor Azmi Kamaruddin, Mohd-Yusof Barakatun-Nisak

Published in: European Journal of Nutrition | Issue 4/2017

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Abstract

Aim

Evidence of a possible connection between gut microbiota and several physiological processes linked to type 2 diabetes is increasing. However, the effect of multi-strain probiotics in people with type 2 diabetes remains unclear. This study investigated the effect of multi-strain microbial cell preparation—also refers to multi-strain probiotics—on glycemic control and other diabetes-related outcomes in people with type 2 diabetes.

Design

A randomized, double-blind, parallel-group, controlled clinical trial.

Setting

Diabetes clinic of a teaching hospital in Kuala Lumpur, Malaysia.

Participants

A total of 136 participants with type 2 diabetes, aged 30–70 years, were recruited and randomly assigned to receive either probiotics (n = 68) or placebo (n = 68) for 12 weeks.

Outcomes

Primary outcomes were glycemic control-related parameters, and secondary outcomes were anthropomorphic variables, lipid profile, blood pressure and high-sensitivity C-reactive protein. The Lactobacillus and Bifidobacterium quantities were measured before and after intervention as an indicator of successful passage of the supplement through gastrointestinal tract.

Statistical analysis

Intention-to-treat (ITT) analysis was performed on all participants, while per-protocol (PP) analysis was performed on those participants who had successfully completed the trial with good compliance rate.

Results

With respect to primary outcomes, glycated hemoglobin decreased by 0.14 % in the probiotics and increased by 0.02 % in the placebo group in PP analysis (p < 0.05, small effect size of 0.050), while these changes were not significant in ITT analysis. Fasting insulin increased by 1.8 µU/mL in placebo group and decreased by 2.9 µU/mL in probiotics group in PP analysis. These changes were significant between groups at both analyses (p < 0.05, medium effect size of 0.062 in PP analysis and small effect size of 0.033 in ITT analysis). Secondary outcomes did not change significantly. Probiotics successfully passed through the gastrointestinal tract.

Conclusion

Probiotics modestly improved HbA1c and fasting insulin in people with type 2 diabetes.
Appendix
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Literature
1.
2.
Wan Nazaimoon WM, Md Isa SH, Wan Mohamad WB et al (2013) Prevalence of diabetes in Malaysia and usefulness of HbA1c as a diagnostic criterion. Diabet Med 30:825–828. doi:10.​1111/​dme.​12161 CrossRef
3.
Firouzi S, Barakatun-Nisak MY, Azmi KN (2015) Nutritional status, glycemic control and its associated risk factors among a sample of type 2 diabetic individuals, a pilot study. J Res Med Sci 20:40–46
4.
5.
Musso G, Gambino R, Cassader M (2010) Obesity, diabetes, and gut microbiota. The hygiene hypothesis expanded? Diabetes Care 33:2277–2284CrossRef
6.
Larsen N, Vogensen FK, van den Berg FWJ et al (2010) Gut microbiota in human adults with type 2 diabetes differs from non-diabetic adults. PLoS ONE 5:e9085CrossRef
7.
8.
FAO/WHO (2002) WHO|guidelines for the evaluation of probiotics in food: joint FAO/WHO working group meeting, London Ontario, Canada, 30 April–1 May 2002. World Health Organization, London Ontario, Canada
9.
10.
Ejtahed HS, Mohtadi Nia J, Homayouni Rad A et al (2011) The effects of probiotic and conventional yoghurt on diabetes markers and insulin resistance in type 2 diabetic patients: a randomized controlled clinical trial. Iran J Endocrinol Metab 13:1–8
11.
Mazloom Z, Yousefinejad A, Dabbaghmanesh MH (2013) Effect of probiotics on lipid profile, glycemic control, insulin action, oxidative stress, and inflammatory markers in patients with type 2 diabetes: a clinical trial. Iran J Med Sci 38:38–43
12.
Asemi Z, Zare Z, Shakeri H et al (2013) Effect of multispecies probiotic supplements on metabolic profiles, hs-CRP, and oxidative stress in patients with type 2 diabetes. Ann Nutr Metab 63:1–9CrossRef
13.
14.
15.
Naito E, Yoshida Y, Makino K et al (2011) Beneficial effect of oral administration of Lactobacillus casei strain Shirota on insulin resistance in diet-induced obesity mice. J Appl Microbiol 110:650–657CrossRef
16.
Chen JJ, Wang R, Li X (2011) Bifidobacterium longum supplementation improved high-fat-fed-induced metabolic syndrome and promoted intestinal Reg I gene expression. Exp Biol Med 236:823–831CrossRef
17.
Jauhiainen T, Collin M, Narva M et al (2005) Effect of long-term intake of milk peptides and minerals on blood pressure and arterial function in spontaneously hypertensive rats. Milchwissenschaft-Milk Sci Int 60:358–362
18.
Agerholm-Larsen L, Raben A, Haulrik N et al (2000) Effect of 8 week intake of probiotic milk products on risk factors for cardiovascular diseases. Eur J Clin Nutr 54:288–297CrossRef
19.
Guo Z, Liu XM, Zhang QX et al (2011) Influence of consumption of probiotics on the plasma lipid profile: a meta-analysis of randomised controlled trials. Nutr Metab Cardiovasc Dis 21:844–850CrossRef
20.
Malaysian Dietitians’ Association (2013) Clinical Practice Guideline, Medical nutrition therapy guideline for type 2 diabetes Mellitus. Ministry of Health, Kuala Lumpur, Malaysia
21.
Cole HS, Camerini-Davalos RA (1970) Diet therapy of diabetes mellitus. Med Clin North Am 54:1577–1587
22.
Krueger KP, Felkey BG, Berger BA (2003) Improving adherence and persistence: a review and assessment of interventions and description of steps toward a national adherence initiative. J Am Pharm Assoc 43:668–679CrossRef
23.
WHO expert consultation (2000) Obesity: preventing and managing the global epidemic Report of a WHO Consultation (WHO Technical Report Series 894). Geneva
24.
Matthews DR, Hosker JP, Rudenski AS et al (1985) Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419CrossRef
25.
Katz A, Nambi SS, Mather K et al (2000) Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab 85:2402–2410CrossRef
26.
Friedewald WT, Levy RI, Fredrickson DS (1972) Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 18:499–502
27.
Chu AHY, Moy FM (2012) Reliability and validity of the malay international physical activity questionnaire (IPAQ-M) among a malay population in Malaysia. Asia Pac J Public Health 27:NP2381–NP2389CrossRef
28.
De Vrese M, Winkler P, Rautenberg P et al (2005) Effect of Lactobacillus gasseri PA 16/8, Bifidobacterium longum SP 07/3, B. bifidum MF 20/5 on common cold episodes: a double blind, randomized, controlled trial. Clin Nutr 24:481–491. doi:10.​1016/​j.​clnu.​2005.​02.​006 CrossRef
29.
30.
31.
Andreasen AS, Larsen N, Pedersen-Skovsgaard T et al (2010) Effects of Lactobacillus acidophilus NCFM on insulin sensitivity and the systemic inflammatory response in human subjects. Br J Nutr 104:1831–1838CrossRef
32.
Laitinen K, Poussa T, Isolauri E (2009) Probiotics and dietary counselling contribute to glucose regulation during and after pregnancy: a randomised controlled trial. Br J Nutr 101:1679–1687CrossRef
33.
Ivey KL, Hodgson JM, Kerr DA et al (2014) The effects of probiotic bacteria on glycaemic control in overweight men and women: a randomised controlled trial. Eur J Clin Nutr 68:447–452. doi:10.​1038/​ejcn.​2013.​294 CrossRef
34.
Gobel RJ, Larsen N, Jakobsen M et al (2012) Probiotics to obese adolescents; RCT examining the effects on inflammation and metabolic syndrome. J Pediatr Gastroenterol Nutr 5:673–678CrossRef
35.
Al-Salami H, Butt G, Fawcett JP et al (2008) Probiotic treatment reduces blood glucose levels and increases systemic absorption of gliclazide in diabetic rats. Eur J Drug Metab Pharmacokinet 33:101–106CrossRef
36.
Zhou J, Martin RJ, Tulley RT et al (2008) Dietary resistant starch upregulates total GLP-1 and PYY in a sustained day-long manner through fermentation in rodents. Am J Physiol Metab 295:E1160–E1166
37.
38.
39.
40.
Burcelin R, Serino M, Chabo C et al (2011) Gut microbiota and diabetes: from pathogenesis to therapeutic perspective. Acta Diabetol 48(4):257–273CrossRef
41.
Pi-Sunyer FX (2005) Weight loss in type 2 diabetic patients. Diabetes Care 28:1526–1527CrossRef
42.
43.
Ejtahed HS, Mohtadi Nia J, Homayouni Rad A et al (2011) Effect of probiotic yogurt containing Lactobacillus acidophilus and Bifidobacterium lactis on lipid profile in individuals with type 2 diabetes mellitus. J Dairy Sci 94:3288–3294CrossRef
44.
45.
46.
47.
48.
Seppo L, Jauhiainen T, Poussa T, Korpela R (2003) A fermented milk high in bioactive peptides has a blood pressure–lowering effect in hypertensive subjects. Am J Clin Nutr 77:326
49.
50.
Ridker PM, Danielson E, Fonseca FA et al (2009) Reduction in C-reactive protein and LDL cholesterol and cardiovascular event rates after initiation of rosuvastatin: a prospective study of the JUPITER trial. Lancet 373:1175–1182. doi:10.​1016/​S0140-6736(09)60447-5 CrossRef
51.
52.
53.
Million M, Angelakis E, Maraninchi M et al (2013) Correlation between body mass index and gut concentrations of Lactobacillus reuteri, Bifidobacterium animalis, Methanobrevibacter smithii and Escherichia coli. Int J Obes 37:1460–1466. doi:10.​1038/​ijo.​2013.​20 CrossRef
54.
55.
56.
Singh B, Saxena A (2010) Surrogate markers of insulin resistance: a review. World J Diabetes 1:36–47CrossRef
57.
58.
59.
60.
61.
Puddu A, Sanguineti R, Montecucco F, Viviani GL (2014) Evidence for the gut microbiota short-chain fatty acids as key pathophysiological molecules improving diabetes. Mediators Inflamm 2014:162021. doi:10.​1155/​2014/​162021
Metadata
Title
Effect of multi-strain probiotics (multi-strain microbial cell preparation) on glycemic control and other diabetes-related outcomes in people with type 2 diabetes: a randomized controlled trial
Authors
Somayyeh Firouzi
Hazreen Abdul Majid
Amin Ismail
Nor Azmi Kamaruddin
Mohd-Yusof Barakatun-Nisak
Publication date
01-06-2017
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nutrition / Issue 4/2017
Print ISSN: 1436-6207
Electronic ISSN: 1436-6215
DOI
https://doi.org/10.1007/s00394-016-1199-8

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