Microbiome research in type 1 diabetes
Few will have noticed that Professor Max Nieuwdorp of Amsterdam UMC has received more than a million euros in subsidy from the Diabetes Fund for microbiome research in patients with type 1 diabetes (T1DM) (1). Previous research has already shown that the microbiome of T1DM patients differs from healthy people, partly due to a reduced number of butyric acid-forming bacteria (2,3). In addition, there is some tentative evidence that probiotic use is associated with a lower risk of T1DM and better glycemic control in T1DM patients (4,5). The Amsterdam UMC has already conducted an exploratory study into faecal transplantation in T1DM patients and will publish this this month in the professional journal Gut (1). The award of this grant is a clear confirmation that the increasing insights about the strong relationship between chronic diseases and gut health are valuable for patients and practitioners.
Microbiome in insulin resistance and type 2 diabetes
There are several strong indications that the microbiome plays a role in insulin resistance and type 2 diabetes mellitus (6,7). It is striking, for example, that metformin – the first-line drug in type 2 diabetes – only works when taken orally (8). Metformin appears to act (in part) via the gut and is associated, for example, with an increase in the mucin-metabolizing Akkermansia muciniphila and in butyric acid-forming bacterial species (9-11). Type 2 diabetes and insulin resistance are associated with systemic low-grade inflammation (12). There is some evidence that the metabolic and immune systems are strongly intertwined, presumably because strong defenses are evolutionarily advantageous but require a lot of energy (13). For example, there is evidence that cytokines act directly as metabolic hormones (13). Given the effects that probiotic strains can have on the immune system, but also on intestinal permeability and butyric acid production, it is therefore not unexpected that meta-analyses of RCTs conclude that probiotics can lower, among other things, Hb1Ac and HOMA-IR (14,15).
References:
- https://www.diabetesfonds.nl/over-diabetes/nieuws/miljoen-euro-voor-onderzoek-poeptransplantatie-bij-diabetes-type-1
- https://doi.org/10.1155/2020/3936247
- https://doi.org/10.3389/fendo.2020.00125
- https://doi.org/10.1001/jamapediatrics.2015.2757
- https://doi.org/4172/2329-8901.1000188
- https://doi.org/10.1210/er.2017-00192
- https://doi.org/10.1172/JCI129194
- https://doi.org/10.1111/j.1464-5491.1992.tb01716.x
- https://doi.org/10.1007/s00125-015-3844-9
- https://doi.org/10.1038/nature15766
- https://doi.org/10.2337/dc16-1324
- http://www.njmonline.nl/njm/getarticle.php?v=71&i=4&p=174
- https://doi.org/10.1038/nature21363
- https://doi.org/10.20452/pamw.3156
- https://doi.org/10.1186/s12967-020-02213-2