Skip to main content
SpringerLink
Log in

The effects of probiotics and synbiotic supplementation on glucose and insulin metabolism in adults with prediabetes: a double-blind randomized clinical trial

Acta Diabetologica Aims and scope Submit manuscript

Cite this article

Abstract

Aims

Probiotics and/or prebiotics could be a promising approach to improve metabolic disorders by favorably modifying the gut microbial composition.

Objectives

To assess the effects of probiotics and synbiotic on glycemic indices in prediabetic individuals who are at risk of type 2 diabetes and its complications.

Methods

In a double-blind, randomized, placebo-controlled parallel-group clinical trial, 120 prediabetic adults participated and were randomly allocated to receive either probiotics or synbiotic or placebo supplements for 24 weeks. Anthropometric measurements, food record, physical activity and glycemic biomarkers including glycated hemoglobin (HbA1C), fasting plasma glucose (FPG), fasting insulin levels (FIL), homoeostasis model assessment for insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and β-cell function (HOMA-B) were assessed at baseline and repeated at 12 and 24 weeks and compared within and between three groups using repeated measure ANOVA.

Results

Compared with the placebo, synbiotic supplementation resulted in a higher significant reduction in FPG (− 6.5 ± 1.6 vs. − 0.82 ± 1.7 mg/dL, P = 0.01), FIL (− 2.6 ± 0.9 vs. − 0.8 ± 0.8 µIU/mL, P = 0.028), and HOMA-IR (− 0.86 ± 0.3 vs. − 0.16 ± 0.25, P = 0.007), and a significant elevation in the QUICKI (+ 0.01 ± 0.003 vs. + 0.003 ± 0.002, P = 0.006). In addition, significant decreases in HbA1C was seen following the supplementation of probiotics and synbiotic compared with the placebo (− 0.12 ± 0.06 and − 0.14 ± 0.05 vs. +0.07 ± 0.06%, P = 0.005 and 0.008, respectively). HOMA-B was not found to be different between or within the three groups.

Conclusion

Glycemic improvement by probiotics and particularly synbiotic supplements in prediabetic individuals has been supported by current study. However, further studies are required for optimal recommendations in this important area of patient treatment.

Trial registration

Iranian Registry of Clinical Trials: IRCT201511032321N2, Date registered February 27, 2016.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Rokana N, Duary RK, Panwar H, Batish VK, Grover S (2012) Management of metabolic syndrome through probiotic and prebiotic interventions. Indian J Endocrinol Metab 16(1):20–27

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Daniele G, Abdul-Ghani M, DeFronzo RA (2014) What are the pharmacotherapy options for treating prediabetes? Expert Opin Pharmacother 15(14):2003–2018

    Article  CAS  PubMed  Google Scholar 

  3. Bansal N (2015) Prediabetes diagnosis and treatment: a review. World J Diabetes 6(2):296–303

    Article  PubMed  PubMed Central  Google Scholar 

  4. He M, Shi B (2017) Gut microbiota as a potential target of metabolic syndrome: the role of probiotics and prebiotics. Cell Biosci 7:54

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Sato J, Kanazawa A, Watada H (2017) Type 2 diabetes and bacteremia. Ann Nutr Metab 71(Suppl 1):17–22

    Article  CAS  PubMed  Google Scholar 

  6. Upadhyaya S, Banerjee G (2015) Type 2 diabetes and gut microbiome: at the intersection of known and unknown. Gut Microbes 6(2):85–92

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Hulston CJ, Churnside AA, Venables MC (2015) Probiotic supplementation prevents high-fat, overfeeding-induced insulin resistance in human subjects. Br J Nutr 113(4):596–602

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Sáez-Lara MJ, Robles-Sanchez C, Ruiz-Ojeda FJ, Plaza-Diaz J, Gil A (2016) Effects of probiotics and synbiotics on obesity, insulin resistance syndrome, type 2 diabetes and non-alcoholic fatty liver disease: a review of human clinical trials. Int J Mol Sci 17(6):928

    Article  CAS  PubMed Central  Google Scholar 

  9. Louis P, Flint HJ, Michel C (2016) How to manipulate the microbiota: prebiotics. Adv Exp Med Biol 902:119–142

    Article  PubMed  Google Scholar 

  10. de Vrese M, Schrezenmeir J (2008) Probiotics, prebiotics, and synbiotics. Adv Biochem Eng Biotechnol 111:1–66

    PubMed  Google Scholar 

  11. Marchesi JR, Adams DH, Fava F, Hermes GD, Hirschfield GM, Hold G et al (2016) The gut microbiota and host health: a new clinical frontier. Gut 65(2):330–339

    Article  PubMed  Google Scholar 

  12. Guiné RPF, Silva ACF (2017) Probiotics, Prebiotics and synbiotics. In: Nelson DL (ed) Functional foods: sources, health effects and future perspectives. Chapter 5. Nova Publishers, New York, 143–207

    Google Scholar 

  13. Poppitt S (2017) Hyperglycaemia, pre-diabetes and diabesity: can we choose who to ‘fast-track’into diabetes prevention? Curr Res Diabetes Obes J 2(3):1–3

    Google Scholar 

  14. Pandis N, Chung B, Scherrer R, Elbourne D, Altman D (2017) CONSORT extension for reporting within-person randomised trials. BMJ 357:1–22

    Google Scholar 

  15. Eslamparast T, Zamani F, Hekmatdoost A, Sharafkhah M, Eghtesad S, Malekzadeh R et al (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(3):438–445

    Article  CAS  PubMed  Google Scholar 

  16. Matthews D, Hosker J, Rudenski A, Naylor B, Treacher D, Turner R (1985) Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28(7):412–419

    Article  CAS  PubMed  Google Scholar 

  17. Hřebíček J, Janout V, Malinčíková J, Horáková D, Čížek L (2002) Detection of insulin resistance by simple quantitative insulin sensitivity check index QUICKI for epidemiological assessment and prevention. J Clin Endocrinol Metab 87(1):144

    Article  PubMed  Google Scholar 

  18. Mossavar-Rahmani Y (2017) Reducing measurement error in nutrition assessment: potential research implications for Iran. Nutr Food Sci Res 4(1):3–10

    Article  Google Scholar 

  19. Strath SJ, Kaminsky LA, Ainsworth BE, Ekelund U, Freedson PS, Gary RA et al (2013) Guide to the assessment of physical activity: clinical and research applications. Circulation 128(20):2259–2279

    Article  PubMed  Google Scholar 

  20. Yao K, Zeng L, He Q, Wang W, Lei J, Zou X (2017) Effect of probiotics on glucose and lipid metabolism in type 2 diabetes mellitus: a meta-analysis of 12 randomized controlled trials. Med Sci Monit 23:3044–3053

    Article  PubMed  PubMed Central  Google Scholar 

  21. Festi D, Schiumerini R, Eusebi LH, Marasco G, Taddia M, Colecchia A (2014) Gut microbiota and metabolic syndrome. World J Gastroenterol WJG 20(43):16079

    Article  PubMed  Google Scholar 

  22. Abrams SA, Griffin IJ, Hawthorne KM, Ellis KJ (2007) Effect of prebiotic supplementation and calcium intake on body mass index. J Pediatr 151(3):293–298

    Article  CAS  PubMed  Google Scholar 

  23. Pedersen C, Lefevre S, Peters V, Patterson M, Ghatei MA, Morgan LM et al (2013) Gut hormone release and appetite regulation in healthy non-obese participants following oligofructose intake. A dose-escalation study. Appetite 66:44–53

    Article  PubMed  Google Scholar 

  24. Franz MJ, VanWormer JJ, Crain AL, Boucher JL, Histon T, Caplan W et al (2007) Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc 107(10):1755–1767

    Article  PubMed  Google Scholar 

  25. Taghizadeh M, Asemi Z (2014) Effects of synbiotic food consumption on glycemic status and serum hs-CRP in pregnant women: a randomized controlled clinical trial. Hormones 13(3):398–406

    PubMed  Google Scholar 

  26. Tabrizi R, Moosazadeh M, Lankarani KB, Akbari M, Heydari ST, Kolahdooz F et al (2017) The effects of synbiotic supplementation on glucose metabolism and lipid profiles in patients with diabetes: a systematic review and meta-analysis of randomized controlled trials. Probiot Antimicrob Proteins. https://doi.org/10.1007/s12602-017-9299-1

    Article  Google Scholar 

  27. Triplot N, Leber B, Blattl D (2012) Effect of supplementation with Lactobacillus casei Shirota on insulin sensitivity, b-cell function, and markers of endothelial function and inflammation in subjects with the metabolic syndrome—a pilot study. J Dairy Sci 96:89–95

    Article  CAS  Google Scholar 

  28. Barazzoni R, Deutz N, Biolo G, Bischoff S, Boirie Y, Cederholm T et al (2017) Carbohydrates and insulin resistance in clinical nutrition: recommendations from the ESPEN expert group. Clin Nutr 36(2):355–363

    Article  CAS  PubMed  Google Scholar 

  29. Cani PD, Amar J, Iglesias MA, Poggi M, Knauf C, Bastelica D et al (2007) Metabolic endotoxemia initiates obesity and insulin resistance. Diabetes 56(7):1761–1772

    Article  CAS  PubMed  Google Scholar 

  30. Allin KH, Nielsen T, Pedersen O (2015) Mechanisms in endocrinology: gut microbiota in patients with type 2 diabetes mellitus. Eur J Endocrinol 172(4):R167–R177

    Article  CAS  PubMed  Google Scholar 

  31. Cani PD, Bibiloni R, Knauf C, Waget A, Neyrinck AM, Delzenne NM et al (2008) Changes in gut microbiota control metabolic endotoxemia-induced inflammation in high-fat diet-induced obesity and diabetes in mice. Diabetes 57(6):1470–1481

    Article  CAS  PubMed  Google Scholar 

  32. Cani PD, Possemiers S, Van de Wiele T, Guiot Y, Everard A, Rottier O et al(2009) Changes in gut microbiota control inflammation in obese mice through a mechanism involving GLP-2-driven improvement of gut permeability. Gut 58(8):1091–1103

    Article  CAS  PubMed  Google Scholar 

  33. Gao Z, Yin J, Zhang J, Ward RE, Martin RJ, Lefevre M et al (2009) Butyrate improves insulin sensitivity and increases energy expenditure in mice. Diabetes 58(7):1509–1517

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Lin HV, Frassetto A, Kowalik EJ Jr, Nawrocki AR, Lu MM, Kosinski JR et al (2012) Butyrate and propionate protect against diet-induced obesity and regulate gut hormones via free fatty acid receptor 3-independent mechanisms. PloS One 7(4):e35240

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Wichmann A, Allahyar A, Greiner TU, Plovier H, Lundén G, Larsson T et al (2013) Microbial modulation of energy availability in the colon regulates intestinal transit. Cell Host Microbe 14(5):582–590

    Article  CAS  PubMed  Google Scholar 

  36. Russo F, Riezzo G, Chiloiro M, De Michele G, Chimienti G, Marconi E et al (2010) Metabolic effects of a diet with inulin-enriched pasta in healthy young volunteers. Curr Pharm Des 16(7):825–831

    Article  CAS  PubMed  Google Scholar 

  37. Kim Y, Keogh J, Clifton P (2017) Probiotics, prebiotics, synbiotics and insulin sensitivity. Nutr Res Rev 17:1–17

    Google Scholar 

  38. Tolhurst G, Heffron H, Lam YS, Parker HE, Habib AM, Diakogiannaki E et al (2012) Short-chain fatty acids stimulate glucagon-like peptide-1 secretion via the G-protein-coupled receptor FFAR2. Diabetes 61(2):364–371

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We would like to thank the study participants for their time and cooperation and the Endocrine and Metabolism Research Center stuff for their collaboration.

Funding

This project was funded by the Isfahan University of Medical Sciences. The funding body played no role in the design, collection, and analysis, interpretation of data, writing of the manuscript or the decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Sedighe Tahere Research Complex, Khoram St., Isfahan, Iran

    Nazila Kassaian, Ashraf Aminorroaya & Masoud Amini

  2. Isfahan Endocrine and Metabolism Research Center and Department of Biostatistics and Epidemiology, Isfahan University of Medical Sciences, Isfahan, Iran

    Awat Feizi

  3. Microbiology Department, Science Faculty, Islamic Azad University (IAU), Arak Branch, Arak, Iran

    Parvaneh Jafari

  4. Microbiology Department, Science Faculty, Islamic Azad University (IAU), Tehran Central Branch, Tehran, Iran

    Maryam Tajabadi Ebrahimi

Authors
  1. Nazila Kassaian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Awat Feizi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ashraf Aminorroaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Parvaneh Jafari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maryam Tajabadi Ebrahimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masoud Amini
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MA, AA, AF, and NK conceptualized the study and are the writing group. NK, MTE, and PJ were main researchers. AF and NK developed the statistical design and analysis. All of the authors have seen and approved the final version of the manuscript.

Corresponding author

Correspondence to Masoud Amini.

Ethics declarations

Conflict of interest

The authors declare no other competing interests.

Ethical approval

This study has been reviewed by the ethics committee of Isfahan University of Medical Sciences and was in accordance with the ethical standards in the last version of Declaration of Helsinky.

Informed consent

All persons gave their informed consent prior to inclusion in the study.

Additional information

Managed by Antonio Secchi.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kassaian, N., Feizi, A., Aminorroaya, A. et al. The effects of probiotics and synbiotic supplementation on glucose and insulin metabolism in adults with prediabetes: a double-blind randomized clinical trial. Acta Diabetol 55, 1019–1028 (2018). https://doi.org/10.1007/s00592-018-1175-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00592-018-1175-2

Keywords

search

Navigation