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Type 1 Diabetes Complications and the Gut Microbiome

New research has suggested that type 1 diabetes complications are associated with changes to the gut microbiome, the collection of dozens of trillions of microscopic organisms that live in our body.

Type 1 Diabetes Complications and the Gut Microbiome

In the study, patients with long-term complications of diabetes – including kidney disease, retinopathy, and higher A1C – showed greater changes to their gut microbiome composition than patients free of those complications. People with type 1 diabetes had significantly higher concentrations of opportunistic “bad” bacteria, and lower concentrations of beneficial commensal bacteria, a trend found in even greater proportions in those with long-term complications.

The data was presented at the recent United European Gastroenterology meeting, held in Vienna last week. Tip of the cap to Medscape, which covered the story first. The summary of results can be found in an abstract published online.

The revelation will not lead immediately to any new treatments. It’s unclear if the relationship is causal, which is to say, we don’t know if the microbiome changes hasten the development of diabetes complications, or if diabetes complications cause changes to the microbiome.

The lead researcher is optimistic. His name is Ranko Gacesa, PhD, of University Medical Center in Groningen, Netherlands, and he explained to Medscape how his work might lead to new therapies:

How our glucose is controlled over a long period of time matters to the gut environment. So, if we make the gut environment healthier, it might promote better control of diabetes … Gut microbiome-based therapies might have an effect on long-term diabetic complications, and based on our data, particularly diabetic nephropathy.

Previous work has already identified links between type 1 diabetes and microbiome changes, though this may be the first effort to tie those changes directly to the disease’s long-term complications. Gacesa noted that other autoimmune diseases, particularly inflammatory bowel disease, also “have a big link to gut bacteria.”

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A moderator at the same presentation suggested that gut microbiome dysregulation may also contribute to the chronic inflammation associated with type 1 diabetes.

Scientists are still only just scratching the surface of the microbiome, and while many researchers believe that the microbiome has a ton of potential for understanding diabetes and developing new diabetes treatments, there remains very little understanding of how well therapies intended to amend the microbiome work.

In our recent article Are Fermented and Probiotic Foods Better for Diabetes?, we found that there is quite a lot of encouraging evidence suggesting that microbiome-strengthening foods might have beneficial long-term health effects. But the evidence is not yet anywhere close to definitive. As of today, we can’t say for certain that the microbiome can be productively improved with targeted food choices, or that a diet full of fermented foods has a strong effect on the health of people with diabetes.

The interactions between the gut microbiome and metabolic health remain largely mysterious, but work like Gacesa’s may help experts piece together a little bit more of the puzzle. There may come a time when people with diabetes have access to validated microbiotic therapies that can improve glucose control and slow the progression of complications.

Diabetes Daily