Are There Differences in Gut Microbiome in Patients with Type 2 Diabetes Treated by Metformin or Metformin and Insulin?

Abstract

Introduction Recently, gut microbiota has been described as being involved in the health and diseases of the host, and together with diet and drugs may influence metabolic health. Yet, there is still no answer which type of treatment plays the most important role in the interplay of gut microbiota and type of treatment for type 2 diabetes (T2DM). An attempt was made to answer the question of which factors have the most significant impact on the intestinal microbiome in the context of metformin or metformin+insulin use in treatment of the patients with T2DM. Thus the aim of the study was to compare the gut microbiome profiles of patients with T2DM and two of the most traditional treatment methods. Methods T2DM patients treated by metformin (Met) and metformin+insulin (Met+Ins), with the treatment duration of 5–10 years were enrolled. Biochemically blood glucose and glycated hemoglobin (HbA1c), lipids and kidney function were investigated and the quantitative and qualitative examination of the fecal intestinal flora were performed through the next-generation sequencing. Results There were no significant differences in the study of the gut microbiome: the dominant bacterial phyla were Firmicutes and Verrucomicrobia , while Bacteroidetes and Proteobacteria shared smaller proportions in both groups. However, the group Met+Ins had worse metabolic control in terms of blood glucose and HbA1c in comparison with the Met group. Conclusion As there are no differences in gut microbiome in T2DM patients treated with metformin only or metformin plus insulin, adding insulin in the treatment of T2DM may delay late diabetic complications development.

Individual gut microbiological signature in obese diabetic spouses – case report and literature review

“…Gut microbiota composition is shaped by hundreds of factors, including host genetics, gender, age, height, weight, diet, immune system, gastrointestinal secretions, blood levels of various molecules or red blood cell counts, stool consistency, sleep, medical history, ethno-geographical and socio-economic conditions, sanitary conditions, smoking, antibiotics and antibiotic-like substances, and laxatives and less intuitive drugs (e.g., antihistamines, antidepressants, and metformin) [19].…”

“…80% of the intestinal microbiome, and Lachnospiraceae, Ruminococcaceae, and Bifidobacteriaceae are the three dominant bacterial families in two type 2 diabetes obese patients analyzed. In healthy people, the dominant gut microbial phyla are Firmicutes, Bacteroidetes, Actinobacteria, Proteobacteria, Fusobacteria, and Verrucomicrobia, with the two phyla Firmicutes and Bacteroidetes representing 90% of gut microbiota [19,20]. Clostridium genera represent 95% of the Firmicutes phyla.…”

Response to Comment to the Article “Are There Differences in Gut Microbiome in Patients with Type 2 Diabetes Treated by Metformin or Metformin and Insulin?” [Response To Letter]

“…In response to Panjaitan et al, the aim of our study was to compare gut microbiome in type 2 diabetes mellitus (T2DM) patients using the most traditional strategy of treatment for the disease (metformin or metformin+insulin) for a long time (treatment duration 5-10 years). 1 The gut microbiome is mutable over time, depending on the health and disease, environment, diet and lifestyle, and, in those with disease, the used strategy of treatment (agents). 2 In the meantime the novel therapeutic strategies for T2DM have been blooming, such as injectable drugs: glucagonlike peptide-1 (GLP-1) receptor agonists and/or oral hypoglycemic agents: sodium-dependent glucose transporter-2 (SGLT-2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors.…”

“…In response to Panjaitan et al, the aim of our study was to compare gut microbiome in type 2 diabetes mellitus (T2DM) patients using the most traditional strategy of treatment for the disease (metformin or metformin+insulin) for a long time (treatment duration 5–10 years). 1 The gut microbiome is mutable over time, depending on the health and disease, environment, diet and lifestyle, and, in those with disease, the used strategy of treatment (agents). 2 …”