Gut microbiome: A revolution in type II diabetes mellitus

Table 2 Effects of diabetic medications on gut microbiome

Medication	Effects on microbiome	Observed outcomes
Metformin[45]	Enhances SCFA production, normalizes Firmicutes/Bacteroides ratio	Increased GLP-1 levels, improved insulin secretion
Sulfonylureas[46,47]	Conflicting data on impact	Variable influence on microbiome, potential increase in phenylalanine and tryptophan levels
Alpha-glucosidase inhibitors[48]	Increases nutrient availability for beneficial bacteria	Growth of beneficial microbes like Bacteroides, improvement in T2DM prognostic factors
GLP-1 agonists[49,50]	Changes in gastric emptying rates influence microbiota	Reduction in obesity-promoting organisms, increase in beneficial microbes like Bifidobacterium
SGLT-2 inhibitors[51]	Alters microbial ratios favorably	Reduction in Firmicutes/Bacteroides ratio, enhanced fatty acid production

DM: Diabetes mellitus; GLP-1: Glucagon-like peptide-1; SCFA: Short-chain fatty acid; SGLT-2: Sodium-glucose co-transporter type 2.