Comparative efficacy and safety of probiotics, prebiotics, and synbiotics for type 2 diabetes management: A systematic review and network meta-analysis
- Diabetes Metab Syndr. 2024 Jan;18(1):102923. doi: 10.1016/j.dsx.2023.102923.
- 1. Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
- 2. Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- 3. Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
- 4. Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
- 5. Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: [email protected].
Aims: To compare the effects of probiotics, prebiotics, and synbiotics for Type 2 Diabetes (T2D) management.
Methods: We searched PubMed, Scopus, CENTRAL, and grey literature sources to December 2022 for randomized trials of the impacts of probiotics, prebiotics, or synbiotics in patients with T2D. We performed network meta-analyses with a Bayesian framework to calculate mean difference [MD] and 95 % credible interval [CrI] and rated the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Results: 68 randomised trials were included. All results are presented in comparison to the placebo. Supplementation with probiotics (MD: -0.25 %, 95%CrI: -0.42, -0.08; GRADE = moderate) and synbiotics (MD: -0.31 %, 95%CrI: -0.61, -0.04; GRADE = very low) resulted in a trivial/unimportant decrease in glycated Hemoglobin. Supplementation with probiotics (MD: -0.69 mmol/L, 95%CrI: -0.98, -0.40; GRADE = very low) and synbiotics (MD: -0.82 mmol/L, 95%CrI: -1.22, -0.43; GRADE = very low) resulted in a trivial/unimportant decrease in fasting plasma glucose. Supplementation with probiotics resulted in a small but important decrease in low-density lipoprotein Cholesterol (MD: -0.19 mmol/L; 95%CrI: -0.34, -0.05; GRADE = very low). Supplementations had moderate effects on serum triglyceride (GRADE = low).
Conclusions: Existing evidence is uncertain and does not support supplementation with probiotics, prebiotics, and synbiotics for T2D management.