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Title: A study to explore the effects of probiotics on endotoxin levels and cardiometabolic indices in patients with type 2 diabetes mellitus
Author: Sabico, Shaun Louie B.
ISNI:       0000 0004 7228 1083
Awarding Body: University of Warwick
Current Institution: University of Warwick
Date of Award: 2018
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Low-grade chronic inflammation in patients with type 2 diabetes mellitus (T2DM) may be influenced by circulating endotoxin levels, acting as an inflammatory stimulus. Health- promoting live microorganisms, such as probiotics, may influence circulating endotoxin levels and reduce inflammation. Limited information is available whether or not probiotics do so in patients with T2DM. The aim of this study was to characterise the beneficial effects of a multi-strain probiotics on circulating endotoxin levels and other biomarkers related to systemic low-grade inflammation and cardiometabolic status in patients with T2DM. A total of 150 adult Saudi T2DM patients (naïve and without co-morbidities, aged 40-60 years) were initially recruited, 96 of whom were randomized, 78 completed 3 months, and 61 completed the entire clinical trial. They were randomized to receive twice daily placebo or probiotics [(2.5×109 cfu/gram) containing the following bacterial strains: Bifidobacterium bifidum W23, Bifidobacterium lactis W52, Lactobacillus acidophilus W37, Lactobacillus brevis W63, Lactobacillus casei W56, Lactobacillus salivarius W24, Lactococcus lactis W19 and Lactococcus lactis W58 (Ecologic®Barrier)] in a double-blind manner over a 6 month period. Anthropometrics, glycaemic and lipid profiles, as well as inflammatory and other markers, including adipocytokines, were measured. Measurements/samples were obtained at baseline and after 3 and 6 months of treatment. After 12/13 weeks of intervention and using intention-to-treat analysis, no difference was noted in endotoxin levels between groups [Placebo -9.5% vs Probiotics -52.2%; (CI: -0.05-0.36; p=0.15)]. Compared with the placebo group however, participants in the probiotics groups had a significant but modest improvement in WHR [Placebo 0.0% vs Probiotics 1.11%; (CI: -0.12- -0.01; p=0.02)] as well as a clinically significant improvement in HOMA-IR [Placebo - 12.2% vs Probiotics -60.4%; (CI: -0.34- -0.01; p=0.04)]. After 6 months of intervention, significant improvements were observed in endotoxin levels, glycaemic, lipid, inflammatory and adipocytokine profiles in the probiotics group, which were not seen in the placebo group. Between group analyses, however, revealed that only HOMA-IR demonstrated a clinically significant reduction in favour of the probiotics group after adjusting for baseline covariates [Placebo % change: 0.80 vs. Probiotics % change: -3.40 (CI: -0.59 - -0.17); p=0.001]. The current thesis expanded our knowledge on the beneficial effects of a multi- strain probiotics intake in improving insulin resistance among Saudi patients with T2DM and is therefore recommended as a promising adjuvant anti-diabetes therapy. Larger trials may causally confirm whether the beneficial effects of probiotics in reducing endotoxin levels may extend in preventing complications of T2DM.
Supervisor: Not available Sponsor: National Plan for Science ; Technology and Innovation
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RC Internal medicine