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World J Methodol. Jul 20, 2022; 12(4): 246-257
Published online Jul 20, 2022. doi: 10.5662/wjm.v12.i4.246
Gut microbiota interactions with anti-diabetic medications and pathogenesis of type 2 diabetes mellitus
Ravi Kant, Lakshya Chandra, Vipin Verma, Priyanshu Nain, Diego Bello, Siddharth Patel, Subash Ala, Rashmi Chandra, Mc Anto Antony
Ravi Kant, Mc Anto Antony, Department of Endocrinology, Diabetes and Metabolism, Medical University of South Carolina, Anderson, SC 29621, United States
Ravi Kant, Mc Anto Antony, Department of Endocrinology, Diabetes and Metabolism, AnMed Health, Anderson, SC 29621, United States
Lakshya Chandra, Subash Ala, Department of Internal Medicine, St Francis Hospital, Greenville, SC 29601, United States
Vipin Verma, Rashmi Chandra, Department of Internal Medicine, Medical University of South Carolina, Anderson, SC 29621, United States
Vipin Verma, Department of Internal Medicine, AnMed Health, Anderson, SC 29621, United States
Priyanshu Nain, Department of Graduate Medical Education, Maulana Azad Medical College, Delhi 110002, India
Diego Bello, Department of Surgery, AnMed Health, Anderson, SC 29621, United States
Siddharth Patel, Department of Internal Medicine, Decatur Morgan Hospital, Decatur, AL 35601, United States
Author contributions: Kant R, Chandra L and Antony MA designed the outline, performed the writing, prepared the figure and edited the paper; Verma V, Nain P, Bello D and Patel S performed the writing, and prepared the table and figure; Ala S and Chandra R provided the input in writing the paper, performed the writing and edited the paper.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ravi Kant, MD, Associate Professor, Department of Endocrinology, Diabetes and Metabolism, Medical University of South Carolina, 2000 E Greenville Street, Suite 3100, Anderson, SC 29621, United States. kant.ravi.md@gmail.com
Received: March 1, 2022
Peer-review started: March 1, 2022
First decision: April 19, 2022
Revised: May 3, 2022
Accepted: June 18, 2022
Article in press: June 18, 2022
Published online: July 20, 2022
Processing time: 141 Days and 2.8 Hours
Abstract

Microorganisms including bacteria, viruses, protozoa, and fungi living in the gastrointestinal tract are collectively known as the gut microbiota. Dysbiosis is the imbalance in microbial composition on or inside the body relative to healthy state. Altered Firmicutes to Bacteroidetes ratio and decreased abundance of Akkermansia muciniphila are the predominant gut dysbiosis associated with the pathogenesis of type 2 diabetes mellitus (T2DM) and metabolic syndrome. Pathophysiological mechanisms linking gut dysbiosis, and metabolic diseases and their complications include altered metabolism of short-chain fatty acids and bile acids, interaction with gut hormones, increased gut microbial metabolite trimethylamine-N-oxide, bacterial translocation/Leaky gut syndrome, and endotoxin production such as lipopolysaccharides. The association between the gut microbiota and glycemic agents, however, is much less understood and is the growing focus of research and conversation. Recent studies suggest that the gut microbiota and anti-diabetic medications are interdependent on each other, meaning that while anti-diabetic medications alter the gut microbiota, the gut microbiota also alters the efficacy of anti-diabetic medications. With increasing evidence regarding the significance of gut microbiota, it is imperative to review the role of gut microbiota in the pathogenesis of T2DM. This review also discusses the interaction between gut microbiota and the various medications used in the treatment of T2DM.

Keywords: Metabolic disease; Gut microbiota; Cardiovascular disease; Short chain fatty acid; Dysbiosis; Trimethylamine-N-oxide

Core Tip: Gut microbiota influence the pathogenesis of type 2 diabetes mellitus (T2DM) and metabolic syndrome through multiple mechanisms. The role of dysbiosis and various pathophysiological mechanisms such as altered metabolism of short-chain fatty acids, interaction with gut hormones, increased gut microbial metabolite trimethylamine-N-oxide and bacterial translocation in the pathogenesis of T2DM and cardio-metabolic diseases have been extensively studied. With increasing evidence regarding the significance of gut microbiota, it is imperative to review the role of gut microbiota in the pathogenesis of T2DM. This review also discusses the interaction between gut microbiota and the various medications used in the treatment of T2DM.