Background. Type 2 diabetes mellitus is characterized by a violation of the incretin effect, in particular a decrease in the secretion of glucagon-like peptide-1 (GLP-1) by intestinal endothelial cells. In recent decades, the intestinal microbiota has been shown to play a key role in the regulation of various metabolic pathways, immune system activity, and intestinal permeability. It has been shown that the composition of bacterial genera in the intestine can unfluence the effectiveness of antidiabetic drugs (eg metformin and GLP-1 receptor agonists), which may be reduced in dysbiosis. Therefore, it is of interest to study the mechanisms that mediate the effect of microbiota on the incretin secretion. The purpose was to establish the relationship between the effects of probiotic therapy, incretin therapy and the level of endogenous GLP-1 in the serum of patients with type 2 diabetes mellitus, taking into account anthropometry and body composition. Materials and methods. We examined 23 patients with type 2 diabetes mellitus (11 women and 12 men), their average age was 56.4 ± 10.5 years (M ± SD). At the beginning of the study, the mean HbA1c level was 7.7 ± 1.5 %; all patients took metformin at an average dose of 1,500 mg/day. Patients were randomized into 2 groups: group 1 (n = 11) received a probiotic, group 2 (n = 12) — a long-acting GLP-1 receptor agonist. The concentration of GLP-1 in the blood serum was determined by the enzyme-linked immunosorbent assay, anthropometry parameters and body composition were assessed using the Tanita analyzer. Results. In the group of patients who took the probiotic, a significant increase in GLP-1 was observed, but less pronounced compared to an increase in GLP-1 level in the group of patients who took GLP-1 receptor agonists. In group 2, on the background of taking GLP-1 receptor agonists, a significant decrease in body weight, total and abdominal fat content, and a decrease in dehydration were revealed. Conclusions. An increase in the concentration of endogenous GLP-1 against the background of probiotic therapy indicates a possible positive effect of normalization of the intestinal microbiota on the secretion of endogenous incretins. The results obtained suggest that the use of a combination of probiotic and GLP-1 receptor agonists may have an additive effect on the hormonal and metabolic profile in patients with type 2 diabetes mellitus.
Mechanisms by Which Glucagon-Like-Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter-2 Inhibitors Reduce Cardiovascular Risk in Adults With Type 2 Diabetes Mellitus
