Association of Diabetes Care & Education Specialists

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Gut Bacteria & Type 2 Diabetes

Oct 07, 2014

I recently attended an interesting presentation given by one of our dietitians on the role of microbiota and its relationship to diabetes - A fascinating angle which sparked my interest to learn more.  My dear friend Google helped me find a significant number of articles published in the past 2-3 years which address this fairly new topic.

Recent studies suggest gut bacteria play a fundamental role in diseases such as obesity, diabetes and cardiovascular disease.  Most authors agree that intestinal bacteria may have a greater influence on us than was previously thought.  More and more data, derived from animal and human studies, suggest obesity and type 2 diabetes are associated with a profound dysbiosis. 

One article states the human body contains ten times more bacteria than our usual human cells.  The majority of these bacteria make up the normal gut microbiota.  These huge numbers of bacterial genes in addition to the genes in our own cells are collectively known as the metagenome.   Swedish researchers compared the metagenome of 145 women with diabetes, impaired glucose tolerance and healthy controls, and showed that women with type 2 diabetes have an altered gut microbiota.  Researchers concluded that by examining the patient's gut microbiota they could predict which patients are at risk of developing diabetes.   In fact, researchers have had better predictive value using gut microbiota than the classical predictive markers used today, such as body-mass index and waist-hip ratio.

The next challenge is to examine whether the composition of the gut microbiota promotes the onset of type 2 diabetes.  If studies show this to be true, this would indicate new opportunities to prevent the disease.   That would add another layer of potential medications or perhaps modifying food choices to assist in the challenges we all face to prevent and treat T2D.

Interestingly, it has been found that certain drugs such as metformin also interfere with the intestinal microbiota.  With so many of our patients using metformin, it would seem important to study this further – perhaps we are making things worse for our patients with the medications we think are helping.  Changes in intestinal microbiota may also explain why gastric bypass surgery is more effective in correcting diabetes than gastric banding.

As more research develops and  a ‘gut signature’ becomes more evident in T2D, a better understanding of the role of the microbiota in diabetes might provide new aspects regarding its pathophysiological relevance and pave the way for new therapeutic principles.

Fascinating information in an entirely new part of the human anatomy - it will be interesting to see where this leads.


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  1. Nov 15, 2014

    Barbara, Very interesting to be sure. I just returned from the Cardiometabolic Health Care Conference held in Boston MA and found the lecture given on this subject to be most interesting as well as promising. Please keep us posted if you hear any new information on this subject. Thank you, Judy P.
  2. Oct 13, 2014

    This is fascinating information that we as diabetes educators should be more aware of. I have been educating myself for some time about this. Another big factor that is contributing to gut dysbiosis is gluten found in wheat products. Most educators recommended a diet high in grains and whole wheat. They are finding that a high percentage of people have a gluten intolerance that does not show up as a true allergy but disrupts the gut microbiota. This leads to leaky gut which triggers inflammation, autoimmune reactions (type 1 DM) and chronic diseases like T2DM (among many other problems). So our dietary recommendations could be making people worse as well. Definitely something we should be focusing on.
  3. Oct 12, 2014

    I am so appreciative of this information written by Barbara Walz. She certainly opened my eyes ib the importance of monitoring metformin patients. Insoluble food and probiotics look like a road to improvement for everyone

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