Effect of probiotics supplementation on glucose and oxidative stress in type 2 diabetes mellitus: a meta-analysis of randomized trials

  • Edris Ardeshirlarijani
  • Ozra Tabatabaei-Malazy
  • Shahrzad Mohseni
  • Mostafa Qorbani
  • Bagher LarijaniEmail author
  • Reza Baradar Jalili
Review article



The role of oxidative stress in pathogenesis of diabetes is well established. In addition, an association between gut microbiota and type 2 diabetes mellitus (T2DM) is widely observed in previously published reports. This meta-analysis critically examines the association between gut microbiota, and oxidative stress in T2DM.


A systematic search for clinical trials was performed in PubMed, Web of Science and Scopus web databases up to 1 Jan 2019. Primary search terms include “microbiota”, “diabetes”, and “oxidative stress”. Study was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline. All clinical trials that compared the effects of probiotic supplementations with a control group using end points serum levels of fasting blood sugar (FBS), hemoglobin A1C (HbA1C) and oxidative stress biomarkers were included. Two independent researchers screened the data extracted from the relevant studies. The pooled standardized mean difference (SMD) was estimated using the random or fixed effects model. Heterogeneity among the studies was assessed using Q-test.


Overall, 13 randomized clinical trials (RCTs) involving 840 subjects with T2DM were included in the meta-analysis. The analysis showed that probiotics intake resulted in significant improvement in serum levels of FBS [SMD: -0.35, 95% CI: (−0.59, −0.12)], total antioxidant status (TAS) [SMD: 0.33, 95% CI: (0.11, 0.55)], total glutathione (GSH) [SMD: 0.41, 95% CI: (0.26, 0.56)] and malondialdehyde (MDA) [SMD: -0.54, 95% CI: (−0.83, −0.26)]. No significant improvement was found in HbA1C [SMD: -0.06, 95% CI:(−0.82, 0.69)], and nitric oxide (NO) [SMD:-0.24, 95% CI:(−1.10, 0.62)] levels.


It seems that gut microbiota can exert beneficial effects in diabetic patients via altering oxidative stress’ biomarkers. The beneficial effect of gut microbiota however was modest on FBS and non-significant on HbA1C. These results need to be confirmed by conducting more reliable RCTs.

PROSPERO Registration number


Graphical abstract

Flow diagram of the study selection process.


Diabetes mellitus type 2 gut microbiota oxidative stress 



This research has been supported by Tehran University of Medical Sciences & health services grant numbered 39856-192-03-97. All of authors thank the TUMS for its financial support.

Authors’ contributions

OTM and EAL did literature bibliography, reviewed data, wrote draft and conceived the paper. SHM and RBJ did literature bibliography, and drafted some parts of the paper. MQ reviewed data, conducted meta-analysis, and drafted the paper. BL conceived, supervised, and edited the paper. All authors read and approved the final manuscript.


This research has been supported by Tehran University of Medical Sciences & health services grant numbered 39856–192–03-97. The funder had no role in any part of study; design, data collection, analysis, interpretation or writing.

Compliance with ethical standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

40199_2019_302_MOESM1_ESM.docx (13 kb)
ESM 1 (DOCX 13 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Edris Ardeshirlarijani
    • 1
  • Ozra Tabatabaei-Malazy
    • 2
    • 3
  • Shahrzad Mohseni
    • 3
  • Mostafa Qorbani
    • 4
  • Bagher Larijani
    • 3
    Email author
  • Reza Baradar Jalili
    • 5
  1. 1.Simon Fraser UniversityBurnabyCanada
  2. 2.Non-Cummunicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
  3. 3.Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
  4. 4.Non-communicable Diseases Research CenterAlborz University of Medical SciencesKarajIran
  5. 5.Department of SurgeryUniversity of British ColumbiaVancouverCanada

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