Abstract
Background: Numerous non-drug therapies have emerged in recent years for the prevention and improvement of type 2 diabetes (T2D). However, therapies based on dietary modification and/or microbiota may replace a large part of drug therapies in the coming years.
Aim: The aim of the current study was to conduct placebo-controlled randomize clinical trial for the efficiency of a combination of multiprobiotics with smectite absorbent gel (Symbiter-Forte formulation) as an adjunction to the standard anti-diabetic therapy.
Methods: A total of 55 patients met the criteria and were included in double-blind single center RCT, to receive “Symbiter-Smectite” or placebo for 8-weeks administered as a sachet formulation. The primary outcome was the change in HOMA2-IR and insulin sensitivity (% S). Secondary outcomes were glycemic control parameters, β-cells functional activity, anthropometric parameters and markers of a chronic systemic inflammatory response.
Results: Combined use of the probiotic mixture with smectite leads to a significant reduction in HOMA2-IR (3.14±0.97 vs 2.79±0.85; р=0.009) and improvement in % S (34.65±9.92 vs 39.42±12.78; p=0.011) after 8 weeks of the treatment period. Simultaneously, in the secondary outcome analysis lowering of HbA1c, waist circumference but not BMI and pro-inflammatory cytokines IL-1β (p=0.004), TNF-α (p=0.008), IL-6 (p=0.005) and IL-8 (p=0.042) were detected. In placebo group, changes were insignificant.
Conclusion: Probiotic with smectite due to its absorbent activity and stabilization mucus layer properties can impact the synergistic enhancement of a single effect, which manifested with a significant reduction in IR, waist circumference, markers of chronic systemic inflammation and improvement of glycemic profile as compared to placebo.
Keywords: Probiotics, smectite, absorbent, insulin resistance, obesity, type 2 diabetes.
Graphical Abstract
[http://dx.doi.org/10.1016/j.aogh.2015.12.015] [PMID: 27108140]
[http://dx.doi.org/10.4239/wjd.v10.i3.154] [PMID: 30891151]
[http://dx.doi.org/10.23736/S0026-4806.18.05897-4] [PMID: 30371047]
[http://dx.doi.org/10.2174/1574887109666141216103908] [PMID: 25514910]
[PMID: 27262256]
[PMID: 19145963]
[http://dx.doi.org/10.1007/s00125-017-4336-x] [PMID: 28770321]
[http://dx.doi.org/10.2174/1574887113666180314100340] [PMID: 29542420]
[http://dx.doi.org/10.1016/j.diabres.2020.108053] [PMID: 32035117]
[http://dx.doi.org/10.1002/cpt.923] [PMID: 29071710]
[http://dx.doi.org/10.3390/nu11112690] [PMID: 31703257]
[http://dx.doi.org/10.1155/2018/5205126] [PMID: 30539026]
[http://dx.doi.org/10.2174/1574887109666141216102458] [PMID: 25514909]
[http://dx.doi.org/10.1007/s12602-016-9230-1] [PMID: 27660157]
[http://dx.doi.org/10.5603/EP.a2017.0055] [PMID: 29022648]
[http://dx.doi.org/10.1016/j.diabres.2018.05.005] [PMID: 29772287]
[http://dx.doi.org/10.1590/1516-3180.2016.0311271216] [PMID: 28538869]
[PMID: 2647564]
[http://dx.doi.org/10.2746/042516403775696384] [PMID: 14649353]
[http://dx.doi.org/10.2165/00148581-200911020-00001] [PMID: 19301931]
[http://dx.doi.org/10.1007/s13105-017-0564-2] [PMID: 28488210]
[http://dx.doi.org/10.5603/DK.2019.0016]
[http://dx.doi.org/10.5604/01.3001.0010.7547] [PMID: 29311399]
[http://dx.doi.org/10.2337/dc19-S002] [PMID: 30559228]
[http://dx.doi.org/10.1186/s41043-015-0034-9] [PMID: 26825666]
[http://dx.doi.org/10.1007/BF00280883] [PMID: 3899825]
[http://dx.doi.org/10.3390/genes8100250] [PMID: 28973971]
[http://dx.doi.org/10.1016/j.dsx.2018.04.015] [PMID: 29661605]
[http://dx.doi.org/10.2337/diacare.23.7.1037] [PMID: 10895873]
[http://dx.doi.org/10.2337/diacare.27.6.1487] [PMID: 15161807]
[http://dx.doi.org/10.1016/j.clnu.2015.11.011] [PMID: 26732026]
[http://dx.doi.org/10.1111/dom.12861] [PMID: 28009106]
[http://dx.doi.org/10.1007/s00394-016-1199-8] [PMID: 26988693]
[http://dx.doi.org/10.1186/ar4405] [PMID: 24321104]
[http://dx.doi.org/10.1371/journal.pone.0132121] [PMID: 26161741]
[http://dx.doi.org/10.20452/pamw.3156] [PMID: 26431318]
[http://dx.doi.org/10.1002/dmrr.3213] [PMID: 31465625]
[http://dx.doi.org/10.1186/s12967-020-02213-2] [PMID: 31952517]
[http://dx.doi.org/10.1038/sj.bjp.0705710] [PMID: 14993105]
[http://dx.doi.org/10.1136/gut.40.3.339] [PMID: 9135522]