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Could Probiotics Aid in the Management of Type 2 Diabetes?

Recently, a new study has been published in which one of Winclove's probiotic formulations  successfully lowers insulin resistance in adults suffering from type 2 diabetes mellitus (T2DM) 1. Could probiotics aid in the management of this type of diabetes?

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The gut microbiota

A dysbiotic microbiome has been linked to several chronic disease such as obesity, T2DM and metabolic syndrome2. Manipulation of the gut microbiome by diet or probiotics has been a supportive measure in the management of most chronic diseases. In fact, a well-controlled diet is a major non-medication option for the prevention of T2DM 3,4. It is thought that low-grade systemic inflammation, which underlies the ethiology of chronic diseases, is caused by the leaking of endotoxins (fragments of gram negative bacteria derived from the gut) from the gut into the circulation5,6. As the gut is the main source of endotoxins, treatment with probiotics may influence the circulating levels of endotoxins by altering the microbiota composition. It has been shown that abnormal alterations in diet and the gut microbiota have a profound influence on endotoxin levels, even more so for patients with T2DM 7. As such, influencing the gut microbiota with probiotics may affect the systemic effects of endotoxin and represent a new and enhanced mechanism to treat conditions in which low-grade chronic inflammation plays a major role, such as T2DM. The present study tested the hypothesis that probiotics can alter the gut microbiota sufficiently to reduce systemic endotoxin levels and the resulting inflammation in patients with T2DM.



Material and methods

A total of 78 adult Saudi T2DM patients participated in this clinical trial and were randomized to receive a placebo or probiotics (2.5 x 10 9) Ecologic® Barrier in a double-blind manner twice daily for 12 weeks. Glycaemic, inflammatory and metabolic measures were obtained at baseline and after 12/13 weeks of treatment.

Did you know?

Diabetes is a worldwide problem affecting 8.5% of the population and a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation  (2014, WHO). The global economic burden of T2DM is estimated at US$1.31 trillion for 2015 (Bommer, 2017).  



Main results       

  • After 12/13 weeks of intervention, no statistically significant difference was observed in endotoxin levels between the two groups. (placebo -9.5% vs probiotics -52.5%; (CI:-0.05-0.36; p=0.15)
  • Within group analyses showed a significant difference in endotoxin levels in the probiotic group after intervention (p<0.01). Participants in the probiotics group had a clinically significant improvement in HOMA-IR (placebo  -12.2% vs. probiotics -60.4%; (CI: -0.34 - -0.01; p=0.04)
  • Compared with the placebo group, participants in the probiotic group had a statistically significant but modest improvement in waist-hip-ration (placebo 0.0% vs probiotics 1.11%; (CI: -0.12- -0.01; p=0.02)




Although endotoxin levels significantly decreased within the probiotics group, no statistically significant difference was observed between the two groups. This can be explained by the high variation of endotoxin levels within the groups. When outcomes highly variate within a group, it is hard to demonstrate a statistically significant difference between the two groups. HOMA-IR is an internationally accepted method used to measure insulin resistance. It calculates how well the body is able to manage blood glucose levels. Blood glucose levels in T2DM patients are commonly managed with both changes in diet and lifestyle, as well as with medication, such as metformin, which can cause nausea and diarrhoea as possible side effects.  Ecologic® Barrier as an adjuvant therapy may reduce or postpone the need for medication thus lowering health care costs. 



Marketing probiotics for diabetes/ metabolic disorders

The formulation used in the publication is Ecologic Barrier, for Winclove these results are promising but too preliminary to position Ecologic Barrier for diabetes. Further research within the field of diabetes is needed to learn more about the mechanisms of action and which formulation suits best within this exciting new indication.



Read the scientific article 


1.     Sabico M, Al-Mashharawi A, Al-Daghri NM, Yakout S, Alnaami AM, Alokail MS, McTernan PG. Efects of a multi-strain probiotic supplement for 12 weeks in circulating endotoxin levels and cardiometabolic profiles of medication naïve T2DM patients; a randomized clinical trial. J. of Trans Medicin 2017

2.     Brunkwall L, Orho-Melander M. The gut microbiome as a target for prevention and treatment of hyperglycaemia in type 2 diabetes: from current human evidence to future possibilities. Diabetologia. 2017;60:943-51.

3.     Firouzi S, Majid HA, Ismail A, Kamaruddin NA, Barakatun-Nisak MY. Effect of multi-strain probiotics (multi-strain microbial cell preparation) on glycemic control and other diabetes-related outcomes in people with type 2 diabetes: a randomized controlled trial. Eur J Nutr 2017;56:1535-50.

4.     Park S, Bae JH. Probiotics for weight loss: a systematic review and meta-analysis. Nutr Res. 2015;35:566-575.

5.     Karamali M, Dadkhah F, Sadrkhanlou M, Jamilian M, Ahmadi S, Tajabadi-Ebrahimi M, Jafari P, Asemi, Z. Effects of probiotic supplementation on glycaemic control and lipid profiles in gestational diabetes: a randomized, double-blind, placebo-controlled trial. Diabetes Metab. 2016;42:234-41.

6.     Chung PH, Wu YY, Chen PH, Fung CP, Hsu CM, Chen LW. Lactobacillus salivarius reverse diabetes-induced intestinal defense impairment in mice through non-defensin protein. J Nutr Biochem 2016;35:48-57.

7.     Lindsay KL, Brennan L, Kennelly MA, Maguire OC, Smith T, Curran S, Coffey M, Foley ME, Hatunic M, Shanahan F, McAuliffe FM. Impact of probiotics in women with gestational diabetes mellitus on metabolic health: a randomized controlled trial. Am J Obstet Gynecol 2015;212:496.e1-11.




Probiotics and insulin-resistance in diabetes

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