Effect of probiotic supplementation on glycemic outcomes in patients with abnormal glucose metabolism: A systematic review and meta-analysis of randomized controlled trials
Abstract
INTRODUCTION: The effectiveness of probiotics in patients with abnormal glucose metabolism has not been clearly demonstrated. It is also unclear if outcomes are consistent across different probiotic formulations. METHODS: A literature search was conducted using PubMed, EMBASE, and Cochrane CENTRAL database from inception through May 2020. Randomized controlled trials that evaluated the effect of probiotics on fasting blood glucose (FBG) or hemoglobin A1c (HbA1c) in patients with prediabetes, type 2 diabetes mellitus, or gestational diabetes were included. Outcomes of interest included FBG, HbA1c, fasting insulin, homeostatic model assessment of insulin resistance (HOMA-IR), homeostatic model assessment of β-cell function (HOMA-B), and quantitative insulin sensitivity check index (QUICKI). Weighted mean difference (WMD) and 95% confidence intervals (CIs) were calculated using the DerSimonian and Laird random-effects model. RESULTS: 31 studies involving 1,948 participants were included in this analysis. Compared to control, probiotics had a significant favorable effect on FBG (WMD -5.77 mg/dL, 95% CI -8.48 to -3.06), HbA1c (WMD -0.32%, 95% CI -0.47 to -0.18), fasting insulin (WMD -2.95 µIU/mL, 95% CI -3.76 to -2.14), HOMA-IR (WMD -0.82, 95% CI -1.05 to -0.59), HOMA-B (WMD -14.86, 95% CI -24.57 to -5.16), and QUICKI (WMD 0.015, 95% CI 0.011-0.019). Further, probiotics were associated with favorable outcomes on all parameters at doses between 1 and 10 × 109 colony-forming unit per day (p < 0.004 for all) and formulations containing 2-4 strains (p < 0.05 for all). DISCUSSION/CONCLUSION: Probiotics appear to have a modest effect on glycemic parameters in patients with abnormal glucose metabolism. Due to the limited number of trials conducted in patients with prediabetes, more studies are warranted in this population.
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Consumption of probiotics can improve inflammatory markers (C-reactive protein) and glycemic control and insulin metabolism in patients diagnosed with type 2 diabetes or metabolic syndrome, including pregnant women with gestational diabetes.
“Studies also show that the consumption of probiotics can improve inflammatory markers (C-reactive protein) and glycemic control and insulin metabolism in patients diagnosed with type 2 diabetes or metabolic syndrome [143,144,145,146,147], including pregnant women with gestational diabetes [143,144].”
From The Potential Impact of Probiotics on Human Health: An Update on Their Health-Promoting Properties (2024) · cites this paper as [145]
Cites
4 retracted
Asemi, Z., Khoramirad, A., Alizadeh, S., Shakeri, H., & Esmaillzadeh, A. (2013) · Clinical Nutrition · doi:10.1016/j.clnu.2013.05.015 · Cited by 190 · see citing works
RetractedBadehnoosh, B., Karamali, M., Zarrati, M., Jamilian, M., Bahmani, F., Ebrahimi, M. T., Jafari, P., Rahmani, E., & Asemi, Z. (2017) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2017.1310193 · Cited by 131 · see citing works
RetractedJamilian, M., Amirani, E., & Asemi, Z. (2018) · Clinical Nutrition · doi:10.1016/j.clnu.2018.10.028 · Cited by 95 · see citing works
RetractedRaygan, F., Ostadmohammadi, V., & Asemi, Z. (2018) · Clinical Nutrition · doi:10.1016/j.clnu.2018.07.017 · Cited by 83 · see citing works
RetractedMeasuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
RoB 2: a revised tool for assessing risk of bias in randomised trials
Sterne, J. A. C., Savović, J., Page, M. J., Elbers, R. G., Blencowe, N. S., Boutron, I., Cates, C. J., Cheng, H.-Y., Corbett, M. S., Eldridge, S. M., et al. (2019) · BMJ · doi:10.1136/bmj.l4898 · Cited by 33,583 · see citing works
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000100 · Cited by 28,164 · see citing works
den Besten, G., van Eunen, K., Groen, A. K., Venema, K., Reijngoud, D.-J., & Bakker, B. M. (2013) · Journal of Lipid Research · doi:10.1194/jlr.r036012 · Cited by 5,048 · see citing works
The role of Gut Microbiota in the development of obesity and Diabetes
Baothman, O. A. S., Zamzami, M. A., Taher, I., Abubaker, J. A., & Abu‐Farha, M. (2016) · Lipids in Health and Disease · doi:10.1186/s12944-016-0278-4 · Cited by 494 · see citing works
Asemi, Z., Zare, Z., Shakeri, H., Sabihi, S.-S., & Esmaillzadeh, A. (2013) · Annals of Nutrition and Metabolism · doi:10.1159/000349922 · Cited by 393 · see citing works
The mechanism of action of probiotics
Boirivant, M., & Strober, W. (2007) · Current Opinion in Gastroenterology · doi:10.1097/mog.0b013e3282f0cffc · Cited by 379 · see citing works
The Effect of Oral Antidiabetic Agents on A1C Levels
Sherifali, D., Nerenberg, K. A., Pullenayegum, E., Cheng, J., & Gerstein, H. C. (2010) · Diabetes Care · doi:10.2337/dc09-1727 · Cited by 317 · see citing works
Mobini, R., Tremaroli, V., Ståhlman, M., Karlsson, F. H., Levin, M., Ljungberg, M., Sohlin, M. C., Forslund, H. B., Perkins, R., Bäckhed, F., et al. (2016) · Diabetes Obesity and Metabolism · doi:10.1111/dom.12861 · Cited by 266 · see citing works
The impact of gut hormones on the neural circuit of appetite and satiety: A systematic review
Zanchi, D., Depoorter, A., Egloff, L., Haller, S., Mählmann, L., Lang, U. E., Drewe, J., Beglinger, C., Schmidt, A., & Borgwardt, S. (2017) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2017.06.013 · Cited by 243 · see citing works
Firouzi, S., Majid, H. A., Ismail, A., Kamaruddin, N. A., & Yusof, B. N. M. (2016) · European Journal of Nutrition · doi:10.1007/s00394-016-1199-8 · Cited by 220 · see citing works
Probiotic supplementation in diabetic hemodialysis patients has beneficial metabolic effects
Soleimani, A., Mojarrad, M. Z., Bahmani, F., Taghizadeh, M., Ramezani, M., Ebrahimi, M. T., Jafari, P., Esmaillzadeh, A., & Asemi, Z. (2016) · Kidney International · doi:10.1016/j.kint.2016.09.040 · Cited by 215 · see citing works
Kobyliak, N. M., Falalyeyeva, T. M., Mykhalchyshyn, G., Kyriienko, D., & Komisarenko, I. (2018) · Diabetes & Metabolic Syndrome Clinical Research & Reviews · doi:10.1016/j.dsx.2018.04.015 · Cited by 198 · see citing works
Zhang, Q., Wu, Y., & Fei, X. (2016) · Medicina · doi:10.1016/j.medici.2015.11.008 · Cited by 197 · see citing works
Hsieh, M., Tsai, W.-H., Jheng, Y.-P., Su, S., Wang, S., Lin, C., Chen, Y.-H., & Chang, W. (2018) · Scientific Reports · doi:10.1038/s41598-018-35014-1 · Cited by 182 · see citing works
Kijmanawat, A., Panburana, P., Reutrakul, S., & Tangshewinsirikul, C. (2018) · Journal of Diabetes Investigation · doi:10.1111/jdi.12863 · Cited by 176 · see citing works
Karamali, M., Dadkhah, F., Sadrkhanlou, M., Jamilian, M., Ahmadi, S., Ebrahimi, M. T., Jafari, P., & Asemi, Z. (2016) · Diabetes & Metabolism · doi:10.1016/j.diabet.2016.04.009 · Cited by 168 · see citing works
Khalili, L., Alipour, B., Jafarabadi, M. A., Faraji, I., Hassanalilou, T., Abbasi, M. M., Vaghef‐Mehrabany, E., & Sani, M. A. (2018) · Iranian Biomedical Journal · doi:10.29252/ibj.23.1.68 · Cited by 153 · see citing works
Mohseni, S., Bayani, M., Bahmani, F., Ebrahimi, M. T., Bayani, M. A., Jafari, P., & Asemi, Z. (2017) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.2970 · Cited by 149 · see citing works
Lindsay, K. L., Brennan, L., Kennelly, M. A., Maguire, O. C., Smith, T., Curran, S., Coffey, M., Foley, M. E., Hatunic, M., Shanahan, F., et al. (2015) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2015.02.008 · Cited by 136 · see citing works
Jafarnejad, S., Saremi, S., Jafarnejad, F., & Arab, A. (2016) · Journal of Nutrition and Metabolism · doi:10.1155/2016/5190846 · Cited by 134 · see citing works
Effectiveness of Multi-strain Versus Single-strain Probiotics
Ouwehand, A. C., Invernici, M. D. M., Furlaneto, F. A. C., & Messora, M. R. (2018) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000001052 · Cited by 130 · see citing works
Taylor, B., Woodfall, G., Sheedy, K., O’Riley, M., Rainbow, K., Bramwell, E., & Kellow, N. J. (2017) · Nutrients · doi:10.3390/nu9050461 · Cited by 128 · see citing works
Raygan, F., Rezavandi, Z., Bahmani, F., Ostadmohammadi, V., Mansournia, M. A., Ebrahimi, M. T., Borzabadi, S., & Asemi, Z. (2018) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-018-0353-2 · Cited by 117 · see citing works
Ebrahimi, M. T., Sharifi, N., Farrokhian, A., Raygan, F., Karamali, F., Razzaghi, R., Taheri, S., & Asemi, Z. (2016) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/s-0042-105441 · Cited by 116 · see citing works
Asemi, Z., Alizadeh, S., Khorshidi, A., Goli, M., & Esmaillzadeh, A. (2015) · Clinical Nutrition · doi:10.1016/j.clnu.2015.07.009 · Cited by 112 · see citing works
Raygan, F., Ostadmohammadi, V., Bahmani, F., & Asemi, Z. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.02.007 · Cited by 112 · see citing works
Ardeshirlarijani, E., Tabatabaei‐Malazy, O., Mohseni, S., Qorbani, M., Larijani, B. A., & Jalili, R. B. (2019) · DARU Journal of Pharmaceutical Sciences · doi:10.1007/s40199-019-00302-2 · Cited by 108 · see citing works
Mafi, A., Namazi, G., Soleimani, A., Bahmani, F., Aghadavod, E., & Asemi, Z. (2018) · Food & Function · doi:10.1039/c8fo00888d · Cited by 102 · see citing works
Kassaian, N., Feizi, A., Aminorroaya, A., Jafari, P., Ebrahimi, M. T., & Amini, M. (2018) · Acta Diabetologica · doi:10.1007/s00592-018-1175-2 · Cited by 101 · see citing works
Madempudi, R. S., Ahire, J. J., Neelamraju, J., Tripathi, A., & Nanal, S. (2019) · PLoS ONE · doi:10.1371/journal.pone.0225168 · Cited by 97 · see citing works
Ebrahimi, Z., Nasli‐Esfahani, E., Nadjarzade, A., & Mozaffari–Khosravi, H. (2017) · Journal of Diabetes & Metabolic Disorders · doi:10.1186/s40200-017-0304-8 · Cited by 91 · see citing works
Babadi, M., Khorshidi, A., Aghadavod, E., Samimi, M., Kavossian, E., Bahmani, F., Mafi, A., Shafabakhsh, R., Sattari, M., & Asemi, Z. (2018) · Probiotics and Antimicrobial Proteins · doi:10.1007/s12602-018-9490-z · Cited by 80 · see citing works
Ahmadi, S., Jamilian, M., Ebrahimi, M. T., Jafari, P., & Asemi, Z. (2016) · British Journal Of Nutrition · doi:10.1017/s0007114516003457 · Cited by 76 · see citing works
Nabhani, Z., Hezaveh, S. J. G., Razmpoosh, E., Jafarabadi, M. A., & Gargari, B. P. (2018) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2018.02.008 · Cited by 73 · see citing works
Soleimani, A., Motamedzadeh, A., Mojarrad, M. Z., Bahmani, F., Amirani, E., Ostadmohammadi, V., Ebrahimi, M. T., & Asemi, Z. (2018) · Probiotics and Antimicrobial Proteins · doi:10.1007/s12602-018-9499-3 · Cited by 63 · see citing works
Peng, T., Wu, T., & Chao, Y. (2018) · Medicina · doi:10.3390/medicina54050077 · Cited by 37 · see citing works
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The Potential Impact of Probiotics on Human Health: An Update on Their Health-Promoting Properties
Maftei, N.-M., Raileanu, C. R., Balta, A. A., Ambrose, L., Boev, M., Marin, D. B., & Lisa, E. L. (2024) · Microorganisms · doi:10.3390/microorganisms12020234 · Cited by 381 · see citing works
Pontes, K. S. D. S., Guedes, M. R., Souza, P. G. D., Neves, M. F. T., & Klein, M. R. S. T. (2025) · Clinical Nutrition · doi:10.1016/j.clnu.2025.05.005 · Cited by 16 · see citing works
- Authors
- Cao, D. X., Wong, E. Y., Vela, M. N., & Le, Q. T.
- Affiliations
- Marshall B. Ketchum University (US)
- ORCID
- Wong, Eva Y.
- Venue
- Annals of Nutrition and Metabolism
- Publisher
- S. Karger AG
- Published
- 2021
- Volume
- 77
- Issue
- 5
- Pages
- 251-261
- ISSN
- 0250-6807 (ISSN-L)
- 1421-9697
- OpenAlex
- W3200984209
- Cited by
- 18
- References
- 41
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 4 · 2023: 1 · 2022: 9
- FWCI
- 0.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Nutrition and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Natural Antidiabetic Agents Studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Keywords
- probiotics, glycemic control, abnormal glucose metabolism, prediabetes, type 2 diabetes, gestational diabetes mellitus, fasting blood glucose, HbA1c, insulin resistance, insulin sensitivity, beta-cell function, probiotic formulation, insulin sensitivity index, HOMA-IR, QUICKI, HOMA-β, fasting insulin
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Type 2, Female, Glucose, Glycated Hemoglobin, Humans, Insulin Resistance, Randomized Controlled Trials as Topic, Probiotics
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