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Metabolic effects of Lactobacillus reuteri DSM 17938 in people with type 2 diabetes: A randomized controlled trial

Journal article
Authors Reza Mobini
Valentina Tremaroli
Marcus Ståhlman
F. Karlsson
Max Levin
Maria Ljungberg
Maja Sohlin
Helene Berteus Forslund
Rosie Perkins
Fredrik Bäckhed
Per-Anders Jansson
Published in Diabetes Obesity & Metabolism
Volume 19
Issue 4
Pages 579-589
ISSN 1462-8902
Publication year 2017
Published at Wallenberg Laboratory
Institute of Clinical Sciences, Department of Radiation Physics
Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 579-589
Language en
Keywords bile acids, gut microbiota, insulin sensitivity, Lactobacillus reuteri DSM 17938, probiotic, controlled clinical-trial, gut microbiota, glucose-homeostasis, insulin-resistance, lipid profile, obesity, probiotics, metaanalysis, management, secretion, Endocrinology & Metabolism
Subject categories Endocrinology and Diabetes


Aims: To investigate the metabolic effects of 12-week oral supplementation with Lactobacillus reuteri DSM 17938 in patients with type 2 diabetes on insulin therapy. Materials and methods: In a double-blind trial, we randomized 46 people with type 2 diabetes to placebo or a low (10(8) CFU/d) or high dose (10(10) CFU/d) of L. reuteri DSM 17938 for 12 weeks. The primary endpoint was the effect of supplementation on glycated haemoglobin (HbA1c). Secondary endpoints were insulin sensitivity (assessed by glucose clamp), liver fat content, body composition, body fat distribution, faecal microbiota composition and serum bile acids. Results: Supplementation with L. reuteri DSM 17938 for 12 weeks did not affect HbA1c, liver steatosis, adiposity or microbiota composition. Participants who received the highest dose of L. reuteri exhibited increases in insulin sensitivity index (ISI) and serum levels of the secondary bile acid deoxycholic acid (DCA) compared with baseline, but these differences were not significant in the between-group analyses. Post hoc analysis showed that participants who responded with increased ISI after L. reuteri supplementation had higher microbial diversity at baseline, and increased serum levels of DCA after supplementation. In addition, increases in DCA levels correlated with improvement in insulin sensitivity in the probiotic recipients. Conclusions: Intake of L. reuteri DSM 17938 for 12 weeks did not affect HbA1c in people with type 2 diabetes on insulin therapy; however, L. reuteri improved insulin sensitivity in a subset of participants and we propose that high diversity of the gut microbiota at baseline may be important.

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