Comparative Efficacy and Safety of Probiotics, Prebiotics, and Synbiotics for Type 2 Diabetes Management: A Systematic Review and Network Meta-Analysis Publisher Pubmed



Jayedi A^{1, 2} ; Aletaha A³ ; Zeraattalabmotlagh S² ; Shahinfar H⁴ ; Mohammadpour S² ; Mirrafiei A² ; Jibril AT² ; Soltani A³ ; Shabbidar S² Show Affiliations
Source: Diabetes and Metabolic Syndrome: Clinical Research and Reviews Published:2024

Abstract

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. © 2023 Research Trust of DiabetesIndia (DiabetesIndia) and National Diabetes Obesity and Cholesterol Foundation (N-DOC)