Diabetes Management by Probiotics: Current Knowledge and Future Perspectives

Diabetes mellitus, a multifactorial disorder, is related to the intestinal microbiota via numerous molecular mechanisms. The vast increase in the prevalence of diabetes and its associated complications requires a natural and safe solution. There is a growing evidence of gut microbiota efficiency in improving insulin resistance, impaired insulin secretion, and metabolic complications in diabetic patients. Probiotics are defined as live microorganisms that, when ingested in adequate amounts, exert health benefits to the host. Probiotics can increase insulin sensitivity and reduce autoimmune responses by modulating intestinal microbiota and decreasing the inflammatory reactions and oxidative stress. Recent evidences show that the intestinal microbiota influences the host through modulating intestinal permeability and mucosal immune response, manipulating eating behaviors by appetite-regulating hormones, including agouti related protein (AgRP), glucagon like peptide-1 (GLP-1) and neuropeptide Y, and controlling gut endocannabinoid (eCB) system which is now believed to be associated with inflammation and diabetes. Moreover, intestinal microbiota control the host metabolism by affecting energy extraction from food and by biochemically converting molecules derived from the host or from gut microbes themselves. Experimental studies and clinical trials support the hypothesis that the modulation of the intestinal microbiota by probiotics, especially Lactobacillus and Bifidobacterium strains may be effective in prevention and management of diabetes. This review will highlight the current evidences in probiotic effectiveness and future prospects for exploring probiotic therapy in prevention and control of diabetes.