Diabetic nephropathy is the loss of kidney function due to diabetes. It is a key cause of end-stage renal disease.
The study showed that a multi-strain probiotics formulation, consisting of Bifidobacterium bifidum, lactobacillus acidophilus, and streptococcus thermophilus, could significantly reduce fasting blood glucose levels from baseline when taken for 12 weeks.
By the end of the study, the amount of glycated haemoglobin and the ratio of microalbumin to creatinine were also lower.
Writing in the Journal of Clinical Laboratory Analysis, the RCT was conducted by researchers from China-Japan Union Hospital Affiliated Jilin University.
Seventy-six patients with diabetic nephropathy completed the trial which took place in endocrinology and metabolic clinics in Changchun, China from January to July 2017.
Randomised into two groups, the intervention group took the multi-strains probiotics with a CFU count of 32bn produced by LactoCare each day, while the control group took placebo.
The researchers explained that the effects of probiotics were studied, as a key difference between diabetic patients and healthy individuals is in their gut microbiome.
“It is well known that intestinal microbial populations vary between healthy individuals and patients with type 2 diabetes.
“Moreover, diabetic nephropathy is characterised by chronic hyper-glycemia with the metabolic imbalance of carbohydrate, fat and protein digestion resulting from defects in insulin sensitivity.
“Therefore, glycaemic control is an essential factor for treatment of DN patients with metabolic syndrome,” the researchers said.
They also cited how existing preclinical and clinical studies have shown benefits of probiotics supplementation in diabetic nephropathy patients.
One example is a RCT conducted by Soleimani et al. It showed that a combination of Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium bifidum could reduce fasting blood glucose and glycated haemoglobin.
“The possible mechanism of hypoglycaemic effect is that probiotics could affect intestinal flora to insulinotropic polypeptides and glucagon‐like peptide‐l, while these peptides induce glucose uptake by muscle,” the researchers said.
Nonetheless, there are also some studies, which showed that probiotic strains such as Lactobacillus reuteri DSM 17938 did not lead to changes such as a lower glycated haemoglobin in diabetic patients.
Hence, the researchers decided to study the impact of probiotic strains which have already shown benefits for glycaemic control in prior studies.
Improvements from baseline
A number of parameters had significantly reduced from baseline levels in the intervention group by the end of this study.
One example is the amount of glycated haemoglobin, which reduced from the baseline level of 8.19 ± 1.60 per cent to 7.32 ± 1.20 per cent.
Fasting blood glucose also significantly dropped from 10.68 ± 3.24 mmol/L to 7.81 ± 2.77 mmol/L.
However, no significant reduction was seen in the 2-hour postprandial blood glucose before and after the trial.
“[This might be] due to the fact that it is difficult to control the postprandial spike in blood sugar in diabetic nephropathy patients,” the researchers said.
On the other hand, while the placebo group also showed a lower fasting blood glucose, 2-hour postprandial blood glucose, and glycated haemoglobin levels, the changes were pre- and post- study were not statistically significant.
Group difference
Except for microalbumin creatinine ratio, there was no significant changes in other parameters between the intervention and placebo groups.
“Only microalbumin creatinine ratio level was significantly lower in the probiotic group than in the placebo group after intervention,” the researchers pointed out.
The microalbumin creatinine ratio represents the kidney’s glomerular filtration function. In normal circumstances, most of the microalbumin will not get through the filtration membrane.
In the intervention group, microalbumin creatinine ratio went down from 101.60 ± 22.17 mg/g to 67.53 ± 20.11mg/g, while that of the placebo group showed a slight drop from 99.66 ± 25.24 mg/g to 87.71 ± 23.01mg/g.
“Consistent with the previous results, probiotics significantly reduced the level of fasting blood glucose and HbA1c, simultaneously reducing the level of microalbumin creatinine ratio, although our results indicated that probiotics showed no significant reduction of 2 h postprandial blood glucose and eGFR.
“Together, our research provided the evidence that probiotics ameliorated glycaemic control of DN patients via recovering the glycaemic control, improving insulin resistance and reducing inflammatory response,” the researchers concluded.
Source: Journal of Clinical Laboratory Analysis
Probiotics ameliorates glycaemic control of patients with diabetic nephropathy: A randomized clinical study
https://doi.org/10.1002/jcla.23650
Authors: Qing Wang, et al
