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Meta-Analysis
. 2024 May 29;16(11):1675.
doi: 10.3390/nu16111675.

The Effect of Microbiome-Modulating Agents (MMAs) on Type 1 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Ying Zhang  1 , Aiying Huang  2 , Jun Li  3 , William Munthali  1 , Saiying Cao  1 , Ulfah Mahardika Pramono Putri  1 , Lina Yang  1
Affiliations
Meta-Analysis

The Effect of Microbiome-Modulating Agents (MMAs) on Type 1 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Ying Zhang et al. Nutrients. .

Abstract

Gut microbiome-modulating agents (MMAs), including probiotics, prebiotics, postbiotics, and synbiotics, are shown to ameliorate type 1 diabetes (T1D) by restoring the microbiome from dysbiosis. The objective of this systematic review and meta-analysis was to assess the impact of MMAs on hemoglobin A1c (HbA1c) and biomarkers associated with (T1D). A comprehensive search was conducted in PubMed, Web of Science, Embase, Cochrane Library, National Knowledge Infrastructure, WeiPu, and WanFang Data up to 30 November 2023. Ten randomized controlled trials (n = 630) were included, with study quality evaluated using the Cochrane risk-of-bias tool. Random-effect models with standardized mean differences (SMDs) were utilized. MMA supplementation was associated with improvements in HbA1c (SMD = -0.52, 95% CI [-0.83, -0.20]), daily insulin usage (SMD = -0.41, 95% confidence interval (CI) [-0.76, -0.07]), and fasting C-peptide (SMD = 0.99, 95% CI [0.17, 1.81]) but had no effects on FBG, CRP, TNF-α, IL-10, LDL, HDL, and the Shannon index. Subgroup analysis of HbA1c indicated that a long-term intervention (>3 months) might exert a more substantial effect. These findings suggest an association between MMAs and glycemic control in T1D. Further large-scale clinical trials are necessary to confirm these findings with investigations on inflammation and gut microbiota composition while adjusting confounding factors such as diet, physical activity, and the dose and form of MMA intervention.

Keywords: meta-analysis; postbiotic; prebiotic; probiotic; randomized controlled trial; synbiotic; type 1 diabetes.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.
Figure 2
Figure 2
Risk-of-bias assessment for the included 10 studies [15,29,30,31,32,33,34,35,36,37].
Figure 3
Figure 3
Forest plot of the effect of MMA intervention on HbA1c [15,29,30,31,32,33,34,35,36,37].
Figure 4
Figure 4
Forest plot of the effect of MMA intervention on daily insulin usage [29,33,37].
Figure 5
Figure 5
Forest plot of the effect of MMA intervention on fasting C-peptide [15,29,33,35,37].
Figure 6
Figure 6
Forest plot of the effect of MMA intervention on HbA1c post-intervention [15,34,37].
Figure 7
Figure 7
Subgroup analysis of the effect of different intervention durations on HbA1c [15,29,30,32,33,34,35,36,37].
Figure 8
Figure 8
Subgroup analysis of the effect of age on HbA1c [15,29,30,32,33,34,35,36,37].
Figure 9
Figure 9
Subgroup analysis of the effect of different MMAs on HbA1c [15,29,30,32,33,34,35,36,37].
Figure 10
Figure 10
Subgroup analysis of the effect of disease duration on HbA1c [15,29,30,32,33,34,35,36,37].
See this image and copyright information in PMC

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