Bağırsak Mikrobiyotası ve Tip 2 Diyabetes Mellitus

Abstract

Tip 2 diyabetes mellitus'un dünya çapındaki prevalansı sürekli olarak artmakta ve halk sağlığı için önemli bir endişe haline gelmektedir. Genetik faktörlerin yanı sıra yaşam tarzı, yüksek enerji ve düşük lifli besinlerin tüketiminin artması ve bağırsak mikrobiyotası gibi birçok faktörün tip 2 diyabete yol açabileceği savunulmaktadır. Son zamanlarda yapılan bazı araştırmalar, bağırsak mikrobiyotasının bileşiminin tip 2 diyabeti tetikleyebileceğini öne sürmektedir. Bağırsak mikrobiyotasındaki değişiklikler bağırsak geçirgenliğinin bozulmasına ve proinflamatuar sitokinlerin salınmasına neden olarak insülin direncine katkıda bulunan metabolik düzenleme sistemleri üzerinde sinerjistik olarak hareket eden kısa zincirli yağ asitlerinin, safra asitlerinin ve diğer metabolitlerin metabolizmasını modüle edebilmektedir. Son yıllarda yapılan kısıtlı sayıdaki çalışmalarda bağırsakta homeostazı sağlayan müdahalelerin insülin sekresyon ve duyarlılığı üzerine yararlı etkilerinin olduğu ve glisemik kontrolü iyileştirdiği görülmektedir. İlerleyen yıllarda yapılacak olan çalışmalarda bağırsak mikrobiyotasının modüle ettiği spesifik yolakları tanımlamak ve tip 2 diyabetin yönetim stratejisinde yeni potansiyel hedeflerini belirlemek için olası patofizyolojik mekanizmalar klinik çalışmalarda daha ayrıntılı olarak incelenmelidir.

Keywords

• Tip 2 diyabet
• insülin direnci
• bağırsak mikrobiyotası
• bağırsak geçirgenliği
• inflamasyon

Gut Microbiota and Type 2 Diabetes

Abstract

Type 2 diabetes is an inflammatory metabolic disease characterized by insulin insufficiency/insufficient use of insulin in the body, the prevalence of which has been increasing (1,2). Environmental factors and genetic predisposition contribute to type 2 diabetes (3). Disruption of the gut microbiota is among the environmental factors contributing to type 2 diabetes (4,5). In this review, the relationship between gut microbiota and type 2 diabetes is summarized. Gut microbiota includes microorganisms such as bacteria, archaea, fungi, and viruses that have settled in the gastrointestinal tract. Some functions of the gut microbiota, which has a symbiotic relationship with the human body, have various effects on human health. These functions are regulation of the immune system and inflammatory processes, ensuring intestinal integrity, regulation of neural signals, and increasing the levels of vitamins and intestinal metabolites (6). Intestinal microbiota includes six bacterial phyla, mainly Firmicutes and Bacteroidetes. Factors such as genetics, mode of birth, breast milk intake, diet, lifestyle, and antibiotic use affect microbiota diversity (8). The intestinal barrier, which prevents the passage of toxins, intestinal bacteria, and bacterial metabolites into the circulation, is protected by intestinal permeability formed by the interconnection of intestinal epithelial cells (9). As a result of the disruption of the intestinal barrier, intestinal permeability increases which leads to translocation of intestinal bacteria into the circulation (6,10). Lipopolysaccharides (LPS) in the cell wall of Gram-negative bacteria increase intestinal permeability. Translocation of LPS into the circulation cause metabolic endotoxemia, leading to low-grade chronic inflammation. The resulting metabolic inflammation increases proinflammatory cytokines and impairs insulin metabolism. Intestinal microbiota is the main factor of the increase in intestinal permeability in type 2 diabetes (11). Therefore, healthy intestinal barrier functions may protect from metabolic diseases such as type 2 diabetes (12).

Keywords

• Type 2 diabetes
• insulin resistance
• gut microbiota
• intestinal permeability
• inflammation

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