Abstract
The gut microbiota has been linked to the emergence of obesity, metabolic syndrome and the onset of type 2 diabetes through decreased glucose tolerance and insulin resistance. Uncontrolled diabetes can lead to serious health consequences such as impaired kidney function, blindness, stroke, myocardial infarction and lower limb amputation. Despite a variety of treatments currently available, cases of diabetes and resulting complications are on the rise. One promising new approach to diabetes focuses on modulating the gut microbiota with probiotics, prebiotics, synbiotics and fecal microbial transplantation. Differences in gut microbiota composition have been observed in preclinical animal models as well as patients with type 2 diabetes and complications such as diabetic nephropathy, diabetic retinopathy, diabetic neuropathy, cerebrovascular disease, coronary heart disease and peripheral artery disease compared to healthy controls. Severity of gut microbiota dysbiosis was associated with disease severity and restoration with probiotic administration in animal models and human patients has been associated with improvement of symptoms and disease progression. Characterizing the gut microbiota dysbiosis in different diseases and determining a causal relationship between the gut microbiota and disease can be beneficial in formulating therapeutic interventions for type 2 diabetes and associated complications. In this review, we present the most important findings regarding the role of the gut microbiota in type 2 diabetes and chronic complications as well as their underlying mechanisms.
Highlights
The gut microbiota is a complex ecosystem made up of a community of microorganisms that include trillions of bacteria spanning at least 1000 different species [1]
While significant strides have been made toward understanding the complex interaction between bacteria and the host, at the biochemical, cellular and molecular level, we are still in the early stages when it comes to our understanding of whether gut bacteria play a direct role in prevention, development and treatment of diseases
As it is the case with most pathologies in which the effects of gut microbiota have been studied, the development of diabetes and its complications have been linked with the state of dysbiosis of the gut microbiota
Summary
The gut microbiota is a complex ecosystem made up of a community of microorganisms that include trillions of bacteria spanning at least 1000 different species [1]. These changes coupled with increased levels of Akkermansia in the gut may contribute to the effects of metformin on glucose metabolism [22] It appears that the metabolic factors associated with chronic low-grade inflammation and oxidative stress, which link gut microbiota dysbiosis and type 2 diabetes, are the same ones that influence the onset and progression of diabetic complications [23,24]. This relationship gives credence to the concept that modulation of the gut microbiota may be a promising strategy in the management of diabetes and associated complications as presented
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