Abstract
Metabolic diseases, especially diabetes mellitus, have become global health issues. The etiology of diabetes mellitus can be attributed to genetic and/or environmental factors. Current evidence suggests the association of gut microbiota with metabolic diseases. However, the effects of glucose-lowering agents on gut microbiota are poorly understood. Several studies revealed that these agents affect the composition and diversity of gut microbiota and consequently improve glucose metabolism and energy balance. Possible underlying mechanisms include affecting gene expression, lowering levels of inflammatory cytokines, and regulating the production of short-chain fatty acids. In addition, gut microbiota may alleviate adverse effects caused by glucose-lowering agents, and this can be especially beneficial in diabetic patients who experience severe gastrointestinal side effects and have to discontinue these agents. In conclusion, gut microbiota may provide a novel viewpoint for the treatment of patients with diabetes mellitus.
Highlights
Over the past few decades, metabolic diseases such as type 2 diabetes mellitus (T2DM), obesity, dyslipidemia, and cardiovascular diseases have become major public health issues all over the world
Several studies reported an association between gut microbiota and metabolic diseases [3,4,5,6,7,8,9], with some studies presenting the differences between gut microbiota in T2DM patients and healthy individuals [3, 10]
Burton et al [28] found that the combination of metformin with GI microbiome modulator (GIMM) in T2DM patients who experienced GI intolerance to metformin resulted in better glucose tolerance compared to placebo and significantly improved fasting glucose levels
Summary
Over the past few decades, metabolic diseases such as type 2 diabetes mellitus (T2DM), obesity, dyslipidemia, and cardiovascular diseases have become major public health issues all over the world. Some probiotic supplements exhibit beneficial metabolic properties [15,16,17] All this information suggests that gut microbiota may be involved in the etiology of diabetes mellitus. A large body of evidence suggests that gut microbiota and SCFAs exhibit positive effects on glucoselowering agents in T2DM. Glucose-lowering agents can influence the composition of gut microbiota [23, 24] and affect the production of SCFAs, thereby leading to significant beneficial effects [1, 25, 26]. This review summarizes current information on the relationship between frequently used glucoselowering agents and gut microbiota (Table 1) to better understand the role of the intestinal microenvironment in the treatment of diabetes mellitus
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