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Metabolic effects of Lactobacillus reuteri DSM 17938 in Patients with Type 2 Diabetes: A Randomized Controlled Trial

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Abstract

Aims

To investigate the metabolic effects of 12-week oral supplementation with Lactobacillus reuteri DSM 17938 in patients with type 2 diabetes on insulin therapy.

Materials and methods

In a double-blind trial, we randomized 46 patients with type 2 diabetes to placebo or a low (108 CFU/day) or high dose (1010 CFU/day) of L. reuteri DSM 17938 for 12 weeks. The primary endpoint was the effect of supplementation on glycated hemoglobin (HbA1c). Secondary endpoints were insulin sensitivity (assessed by glucose clamp), liver fat content, body composition, body fat distribution, fecal microbiota composition and serum bile acids.

Results

Supplementation with L. reuteri DSM 17938 for 12 weeks did not affect HbA1c, liver steatosis, adiposity, or microbiota composition. Patients who received the highest dose of L. reuteri exhibited increases in insulin sensitivity index (ISI) and serum levels of the secondary bile acid deoxycholic acid (DCA) compared with baseline, but these differences were not significant in the between-group analyses. Post-hoc analysis showed that patients who responded with increased ISI following L. reuteri supplementation had higher microbial diversity at baseline, and increased serum levels of DCA after supplementation. In addition, increases in DCA levels correlated with improvement in insulin sensitivity in the probiotic recipients.

Conclusions

Intake of L. reuteri DSM 17938 for 12 weeks did not affect HbA1c in patients with type 2 diabetes on insulin therapy. However, L. reuteri improved insulin sensitivity in a subset of patients and we propose that high diversity of the gut microbiota at baseline may be important.

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