Effect of probiotics and synbiotics on blood glucose: a systematic review and meta-analysis of controlled trials



High fasting blood glucose (FBG) can lead to chronic diseases such as diabetes mellitus, cardiovascular and kidney diseases. Consuming probiotics or synbiotics may improve FBG. A systematic review and meta-analysis of controlled trials was conducted to clarify the effect of probiotic and synbiotic consumption on FBG levels.


PubMed, Scopus, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature databases were searched for relevant studies based on eligibility criteria. Randomized or non-randomized controlled trials which investigated the efficacy of probiotics or synbiotics on the FBG of adults were included. Studies were excluded if they were review articles and study protocols, or if the supplement dosage was not clearly mentioned.


A total of fourteen studies (eighteen trials) were included in the analysis. Random-effects meta-analyses were conducted for the mean difference in FBG. Overall reduction in FBG observed from consumption of probiotics and synbiotics was borderline statistically significant (−0.18 mmol/L 95 % CI −0.37, 0.00; p = 0.05). Neither probiotic nor synbiotic subgroup analysis revealed a significant reduction in FBG. The result of subgroup analysis for baseline FBG level ≥7 mmol/L showed a reduction in FBG of 0.68 mmol/L (−1.07, −0.29; ρ < 0.01), while trials with multiple species of probiotics showed a more pronounced reduction of 0.31 mmol/L (−0.58, −0.03; ρ = 0.03) compared to single species trials.


This meta-analysis suggests that probiotic and synbiotic supplementation may be beneficial in lowering FBG in adults with high baseline FBG (≥7 mmol/L) and that multispecies probiotics may have more impact on FBG than single species.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2


  1. 1.

    American Diabetes Association (2012) Diagnosis and classification of diabetes mellitus. Diabetes Care 35(Suppl 1):S64–S71. doi:10.2337/dc12-s064

    Article  Google Scholar 

  2. 2.

    Al-Salami H (2008) Probiotic treatment reduces blood glucose and increases systemic absorption of gliclazide in diabetic rats. In: 2nd Asian Pacific ISSX Meeting

  3. 3.

    Asemi Z, Zare Z, Shakeri H, Sabihi SS, Esmaillzadeh A (2013) Effect of multispecies probiotic supplements on metabolic profiles, hs-CRP, and oxidative stress in patients with type 2 diabetes. Ann Nutr Metab 63:1–9

    CAS  Article  Google Scholar 

  4. 4.

    Association AD (2001) Postprandial Blood Glucose. Diabetes Care 24:775–778

    Article  Google Scholar 

  5. 5.

    Aureli P, Capurso L, Castellazzi AM, Clerici M, Giovannini M, Morelli L, Poli A, Pregliasco F, Salvini F, Zuccotti GV (2011) Probiotics and health: an evidence-based review. Pharmacol Res 63:366–376

    CAS  Article  Google Scholar 

  6. 6.

    Barreto FM, Colado Simão AN, Morimoto HK, Batisti Lozovoy MA, Dichi I, da Silva Helena, Miglioranza L (2014) Beneficial effects of Lactobacillus plantarum on glycemia and homocysteine levels in postmenopausal women with metabolic syndrome. Nutrition 30:939–942

    CAS  Article  Google Scholar 

  7. 7.

    Bastard J-P, Maachi M, Lagathu C, Kim MJ, Caron M, Vidal H, Capeau J, Feve B (2006) Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur Cytokine Netw 17:4–12

    CAS  Google Scholar 

  8. 8.

    Bengmark S, Martindale R (2005) Prebiotics and synbiotics in clinical medicine. Nutr in Clin Pract 20:244–261

    Article  Google Scholar 

  9. 9.

    Broekaert WF, Courtin CM, Verbeke K, Van de Wiele T, Verstraete W, Delcour JA (2011) Prebiotic and other health-related effects of cereal-derived arabinoxylans, arabinoxylan-oligosaccharides, and xylooligosaccharides. Crit Rev Food Sci Nutr 51:178–194

    CAS  Article  Google Scholar 

  10. 10.

    Bruce SP, Acheampong F, Kretchy I (2015) Adherence to oral anti-diabetic drugs among patients attending a Ghanaian teaching hospital. Pharm Pract (Granada) 13:533

    Article  Google Scholar 

  11. 11.

    Cani PD, Bibiloni R, Knauf C, Waget A, Neyrinck AM, Delzenne NM, Burcelin R (2008) Changes in gut microbiota control metabolic endotoxemia-induced inflammation in high-fat diet–induced obesity and diabetes in mice. Diabetes 57:1470–1481

    CAS  Article  Google Scholar 

  12. 12.

    Cani PD, Joly E, Horsmans Y, Delzenne NM (2006) Oligofructose promotes satiety in healthy human: a pilot study. Eur J Clin Nutr 60:567–572

    CAS  Article  Google Scholar 

  13. 13.

    Cani PD, Lecourt E, Dewulf EM, Sohet FM, Pachikian BD, Naslain D, De Backer F, Neyrinck AM, Delzenne NM (2009) Gut microbiota fermentation of prebiotics increases satietogenic and incretin gut peptide production with consequences for appetite sensation and glucose response after a meal. Am J Clin Nutr 90:1236–1243

    CAS  Article  Google Scholar 

  14. 14.

    Cani PD, Neyrinck AM, Fava F, Knauf C, Burcelin RG, Tuohy KM, Gibson G, Delzenne NM (2007) Selective increases of bifidobacteria in gut microflora improve high-fat-diet-induced diabetes in mice through a mechanism associated with endotoxaemia. Diabetologia 50:2374–2383

    CAS  Article  Google Scholar 

  15. 15.

    Cefalu WT (2006) Animal models of type 2 diabetes: clinical presentation and pathophysiological relevance to the human condition. ILAR J 47:186–198

    CAS  Article  Google Scholar 

  16. 16.

    Ceriello A (2005) Postprandial hyperglycemia and diabetes complications is it time to treat? Diabetes 54:1–7

    CAS  Article  Google Scholar 

  17. 17.

    Chapman C, Gibson GR, Rowland I (2011) Health benefits of probiotics: are mixtures more effective than single strains? Eur J Nutr 50:1–17

    CAS  Article  Google Scholar 

  18. 18.

    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    CAS  Article  Google Scholar 

  19. 19.

    Ejtahed HS, Mohtadi-Nia J, Homayouni-Rad A, Niafar M, Asghari-Jafarabadi M, Mofid V (2012) Probiotic yogurt improves antioxidant status in type 2 diabetic patients. Nutrition 28:539–543

    CAS  Article  Google Scholar 

  20. 20.

    Eslamparast T, Zamani F, Hekmatdoost A, Sharafkhah M, Eghtesad S, Malekzadeh R, Poustchi H (2014) Effects of synbiotic supplementation on insulin resistance in subjects with the metabolic syndrome: a randomised, double-blind, placebo-controlled pilot study. Br J Nutr 112:438–445

    CAS  Article  Google Scholar 

  21. 21.

    Fujimura KE, Slusher NA, Cabana MD, Lynch SV (2010) Role of the gut microbiota in defining human health. Expert Rev Anti Infect Ther 8(4):435–454. doi:10.1586/eri.10.14

    Article  Google Scholar 

  22. 22.

    Gannon MC, Nuttall FQ (2006) Control of blood glucose in type 2 diabetes without weight loss by modification of diet composition. Nutr Metab 3:1

    Article  Google Scholar 

  23. 23.

    Gmeiner M, Kneifel W, Kulbe K, Wouters R, De Boever P, Nollet L, Verstraete W (2000) Influence of a synbiotic mixture consisting of Lactobacillus acidophilus 74-2 and a fructooligosaccharide preparation on the microbial ecology sustained in a simulation of the human intestinal microbial ecosystem (SHIME reactor). Appl Microbiol and Biotechnol 53:219–223

    CAS  Article  Google Scholar 

  24. 24.

    Griffiths EA, Duffy LC, Schanbacher FL, Qiao H, Dryja D, Leavens A, Rossman J, Rich G, Dirienzo D, Ogra PL (2004) In vivo effects of bifidobacteria and lactoferrin on gut endotoxin concentration and mucosal immunity in Balb/c mice. Dig Dis and Sci 49:579–589

    CAS  Article  Google Scholar 

  25. 25.

    Harisa G, Taha E, Khalil A, Salem M (2009) Oral administration of Lactobacillus acidophilus restores nitric oxide level in diabetic rats. Aust J Basic Appl Sci 3:2963–2969

    CAS  Google Scholar 

  26. 26.

    Higgins J, Deeks JJ, Altman DG (2008) Special topics in statistics. Cochrane handbook for systematic reviews of interventions: Cochrane book series:481-529

  27. 27.

    Iannitti T, Palmieri B (2010) Therapeutical use of probiotic formulations in clinical practice. Clin Nutr 29:701–725

    CAS  Article  Google Scholar 

  28. 28.

    Ivey KL, Hodgson JM, Kerr DA, Lewis JR, Thompson PL, Prince RL (2014) The effects of probiotic bacteria on glycaemic control in overweight men and women: a randomised controlled trial. Eur J Clin Nutr 68:447–452

    CAS  Article  Google Scholar 

  29. 29.

    Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clin Trials 17:1–12

    CAS  Article  Google Scholar 

  30. 30.

    Jones ML, Martoni CJ, Tamber S, Parent M, Prakash S (2012) Evaluation of safety and tolerance of microencapsulated Lactobacillus reuteri NCIMB 30242 in a yogurt formulation: a randomized, placebo-controlled, double-blind study. Food Chem Toxicol 50:2216–2223. doi:10.1016/j.fct.2012.03.010

    CAS  Article  Google Scholar 

  31. 31.

    Jung SP, Lee KM, Kang JH, Yun SI, Park HO, Moon Y, Kim JY (2013) Effect of Lactobacillus gasseri BNR17 on overweight and obese adults: a randomized, double-blind clinical trial. Korean J Family Med 34:80–89

    Article  Google Scholar 

  32. 32.

    Khalesi S, Sun J, Buys N, Jayasinghe R (2014) Effect of probiotics on blood pressure a systematic review and meta-analysis of randomized, controlled trials. Hypertension 64:897–903

    CAS  Article  Google Scholar 

  33. 33.

    Klein S, Sheard NF, Pi-Sunyer X, Daly A, Wylie-Rosett J, Kulkarni K, Clark NG (2004) Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies a statement of the american diabetes association, the north american association for the study of obesity, and the american society for clinical nutrition. Diabetes Care 27:2067–2073

    Article  Google Scholar 

  34. 34.

    Kootte R, Vrieze A, Holleman F, Dallinga-Thie GM, Zoetendal EG, de Vos WM, Groen A, Hoekstra JB, Stroes ES, Nieuwdorp M (2012) The therapeutic potential of manipulating gut microbiota in obesity and type 2 diabetes mellitus. Diabetes Obes Metab 14:112–120

    CAS  Article  Google Scholar 

  35. 35.

    Kopp-Hoolihan L (2001) Prophylactic and Therapeutic Uses of Probiotics: a review. J Am Diet Assoc 101:229–241. doi:10.1016/S0002-8223(01)00060-8

    CAS  Article  Google Scholar 

  36. 36.

    Lenoir-Wijnkoop I, Sanders ME, Cabana MD, Caglar E, Corthier G, Rayes N, Sherman PM, Timmerman HM, Vaneechoutte M, Van Loo J (2007) Probiotic and prebiotic influence beyond the intestinal tract. Nutr Rev 65:469–489

    Article  Google Scholar 

  37. 37.

    Meyer D, Stasse-Wolthuis M (2009) The bifidogenic effect of inulin and oligofructose and its consequences for gut health. Eur J Clin Nutr 63:1277–1289

    CAS  Article  Google Scholar 

  38. 38.

    Mohamadshahi M, Veissi M, Haidari F, Shahbazian H, Kaydani GA, Mohammadi F (2014) Effects of probiotic yogurt consumption on inflammatory biomarkers in patients with type 2 diabetes. BioImpacts 4:83–88

    CAS  Google Scholar 

  39. 39.

    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269

    Article  Google Scholar 

  40. 40.

    Musso G, Gambino R, Cassader M (2010) Obesity, diabetes, and gut microbiota: the hygiene hypothesis expanded? Diabetes Care 33:2277–2284. doi:10.2337/dc10-0556

    Article  Google Scholar 

  41. 41.

    Naito E, Yoshida Y, Makino K, Kounoshi Y, Kunihiro S, Takahashi R, Matsuzaki T, Miyazaki K, Ishikawa F (2011) Beneficial effect of oral administration of lactobacillus casei strain shirota on insulin resistance in diet-induced obesity mice. J Appl Microbiol 110:650–657

    CAS  Article  Google Scholar 

  42. 42.

    Nishida C, Uauy R, Kumanyika S, Shetty P (2004) The joint WHO/FAO expert consultation on diet, nutrition and the prevention of chronic diseases: process, product and policy implications. Publ Health Nutr 7:245–250

    Google Scholar 

  43. 43.

    Ogawa A, Kadooka Y, Kato K, Shirouchi B, Sato M (2014) Lactobacillus gasseri SBT2055 reduces postprandial and fasting serum non-esterified fatty acid levels in Japanese hypertriacylglycerolemic subjects. Lipids Health Dis 13:36. doi:10.1186/1476-511x-13-36

    Article  Google Scholar 

  44. 44.

    Ostadrahimi A, Taghizadeh A, Mobasseri M, Farrin N, Payahoo L, Gheshlaghi ZB, Vahedjabbari M (2015) Effect of probiotic fermented milk (kefir) on glycemic control and lipid profile in type 2 diabetic patients: a randomized double-blind placebo-controlled clinical trial. Iranian J Publ Health 44:228

    Google Scholar 

  45. 45.

    Pais I, Hallschmid M, Jauch-Chara K, Schmid SM, Oltmanns KM, Peters A, Born J, Schultes B (2007) Mood and cognitive functions during acute euglycaemia and mild hyperglycaemia in type 2 diabetic patients. Exp Clin Endocrinol Diabetes 115:42–46. doi:10.1055/s-2007-957348

    CAS  Article  Google Scholar 

  46. 46.

    Panwar H, Rashmi HM, Batish VK, Grover S (2013) Probiotics as potential biotherapeutics in the management of type 2 diabetes–prospects and perspectives. Diabetes/metabolism Res and Rev 29:103–112

    CAS  Article  Google Scholar 

  47. 47.

    Parnell JA, Reimer RA (2009) Weight loss during oligofructose supplementation is associated with decreased ghrelin and increased peptide YY in overweight and obese adults. Am J Clin Nutr 89:1751–1759

    CAS  Article  Google Scholar 

  48. 48.

    Pimentel D, Pimentel MH (2007) Food, energy, and society. CRC Press, Boca Raton

    Google Scholar 

  49. 49.

    Qin J, Li R, Raes J, Arumugam M, Burgdorf KS, Manichanh C, Nielsen T, Pons N, Levenez F, Yamada T (2010) A human gut microbial gene catalogue established by metagenomic sequencing. Nature 464:59–65

    CAS  Article  Google Scholar 

  50. 50.

    Rajkumar H, Mahmood N, Kumar M, Varikuti SR, Challa HR, Myakala SP (2014) Effect of probiotic (VSL# 3) and omega-3 on lipid profile, insulin sensitivity, inflammatory markers, and gut colonization in overweight adults: a randomized, controlled trial. Mediators Inflamm 2014

  51. 51.

    Rijkers GT, De Vos WM, Brummer R-J, Morelli L, Corthier G, Marteau P (2011) Health benefits and health claims of probiotics: bridging science and marketing. Br J Nutr 106:1291–1296

    CAS  Article  Google Scholar 

  52. 52.

    Shakeri H, Hadaegh H, Abedi F, Tajabadi-Ebrahimi M, Mazroii N, Ghandi Y, Asemi Z (2014) Consumption of synbiotic bread decreases triacylglycerol and VLDL levels while increasing HDL levels in serum from patients with type-2 diabetes. Lipids 49:695–701

    CAS  Article  Google Scholar 

  53. 53.

    Sharafedtinov KK, Plotnikova OA, Alexeeva RI, Sentsova TB, Songisepp E, Stsepetova J, Smidt I, Mikelsaar M (2013) Hypocaloric diet supplemented with probiotic cheese improves body mass index and blood pressure indices of obese hypertensive patients–A randomized double-blind placebo-controlled pilot study. Nutrition Journal 12

  54. 54.

    Shavakhi A, Minakari M, Firouzian H, Assali R, Hekmatdoost A, Ferns G (2013) Effect of a probiotic and metformin on liver aminotransferases in non-alcoholic steatohepatitis: a double blind randomized clinical trial. Int J Prev Med 4:531–537

    Google Scholar 

  55. 55.

    Silk D, Davis A, Vulevic J, Tzortzis G, Gibson G (2009) Clinical trial: the effects of a trans-galactooligosaccharide prebiotic on faecal microbiota and symptoms in irritable bowel syndrome. Aliment Pharmacol Ther 29:508–518

    CAS  Article  Google Scholar 

  56. 56.

    Sonnenburg JL, Chen CT, Gordon JI (2006) Genomic and metabolic studies of the impact of probiotics on a model gut symbiont and host. PLoS Biol 4:e413

    Article  Google Scholar 

  57. 57.

    Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR (2000) Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 321:405–412

    CAS  Article  Google Scholar 

  58. 58.

    Tabuchi M, Ozaki M, Tamura A, Yamada N, Ishida T, Hosoda M, Hosono A (2003) Antidiabetic effect of Lactobacillus GG in streptozotocin-induced diabetic rats. Biosci Biotechnol Biochem 67:1421–1424

    CAS  Article  Google Scholar 

  59. 59.

    Thomas CM, Versalovic J (2010) Probiotics-host communication: modulation of signaling pathways in the intestine. Gut Microbes 1:148–163

    Article  Google Scholar 

  60. 60.

    Tripolt NJ, Leber B, Blattl D, Eder M, Wonisch W, Scharnagl H, Stojakovic T, Obermayer-Pietsch B, Wascher TC, Pieber TR, Stadlbauer V, Sourij H (2013) Short communication: effect of supplementation with Lactobacillus casei Shirota on insulin sensitivity, β-cell function, and markers of endothelial function and inflammation in subjects with metabolic syndrome-A pilot study. J Dairy Sci 96:89–95

    CAS  Article  Google Scholar 

  61. 61.

    Tuohy K, Rouzaud G, Bruck W, Gibson G (2005) Modulation of the human gut microflora towards improved health using prebiotics-assessment of efficacy. Curr Pharm Des 11:75–90

    CAS  Article  Google Scholar 

  62. 62.

    Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N.Engl J Med 344:1343–1350

    CAS  Article  Google Scholar 

  63. 63.

    van Baarlen P, Troost F, van der Meer C, Hooiveld G, Boekschoten M, Brummer RJ, Kleerebezem M (2011) Human mucosal in vivo transcriptome responses to three lactobacilli indicate how probiotics may modulate human cellular pathways. Proc of the Natl Academy of Sci USA 108(Suppl 1):4562–4569. doi:10.1073/pnas.100007910

    Article  Google Scholar 

  64. 64.

    van Rosendal SP, Osborne MA, Fassett RG, Coombes JS (2010) Guidelines for glycerol use in hyperhydration and rehydration associated with exercise. Sports Med 40:113–139

    Article  Google Scholar 

  65. 65.

    WHO J, Consultation FE (1990) Diet, nutrition and the prevention of chronic diseases. World Health Organization Geneva

  66. 66.

    Williams R, Van Gaal L, Lucioni C (2002) Assessing the impact of complications on the costs of Type II diabetes. Diabetologia 45:S13–S17

    Article  Google Scholar 

  67. 67.

    Wos-Oxley M, Bleich A, Oxley AP, Kahl S, Janus LM, Smoczek A, Nahrstedt H, Pils MC, Taudien S, Platzer M, Hedrich HJ, Medina E, Pieper DH (2012) Comparative evaluation of establishing a human gut microbial community within rodent models. Gut Microbes 3:234–249. doi:10.4161/gmic.19934

    Article  Google Scholar 

  68. 68.

    Yadav H, Jain S, Sinha P (2007) Antidiabetic effect of probiotic dahi containing Lactobacillus acidophilus and Lactobacillus casei in high fructose fed rats. Nutrition 23:62–68

    Article  Google Scholar 

  69. 69.

    Yadav H, Jain S, Sinha P (2008) The effect of probiotic dahi containing Lactobacillus acidophilus and Lactobacillus casei on gastropathic consequences in diabetic rats. J Med Food 11:62–68

    CAS  Article  Google Scholar 

  70. 70.

    Yamano T, Tanida M, Niijima A, Maeda K, Okumura N, Fukushima Y, Nagai K (2006) Effects of the probiotic strain Lactobacillus johnsonii strain La1 on autonomic nerves and blood glucose in rats. Life Sci 79:1963–1967

    CAS  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Saman Khalesi.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 23 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Nikbakht, E., Khalesi, S., Singh, I. et al. Effect of probiotics and synbiotics on blood glucose: a systematic review and meta-analysis of controlled trials. Eur J Nutr 57, 95–106 (2018). https://doi.org/10.1007/s00394-016-1300-3

Download citation


  • Probiotics
  • Synbiotics
  • Fasting blood glucose
  • Hyperglycemia