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Effects of probiotic supplementation on intestinal microbiota in patients with diabetes/prediabetes: a systematic review and meta-analysis of randomized controlled trials

Published online by Cambridge University Press:  26 December 2025

Lifen Hong ,
Yan Zheng ,
Wang Yang ,
Mingqian Jiang ,
Kailin Zheng ,
Shanyi Shen ,
Hairui Han ,
Shujie Xia Open the ORCID record for Shujie Xia [Opens in a new window] ,
Zhaoyang Yang  and
Candong Li
Lifen Hong
Affiliation:
Department of General Practice, People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350000, People’s Republic of China
Yan Zheng
Affiliation:
Health Management Center (Preventive Medicine), the Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350000, People’s Republic of China
Wang Yang
Affiliation:
College of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350000, People’s Republic of China
Mingqian Jiang
Affiliation:
Department of Endocrinology and Metabolism, People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350000, People’s Republic of China
Kailin Zheng
Affiliation:
Department of Clinical Nutrition, People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350000, People’s Republic of China
Shanyi Shen
Affiliation:
College of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350000, People’s Republic of China
Hairui Han
Affiliation:
College of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350000, People’s Republic of China
Shujie Xia*
Affiliation:
College of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350000, People’s Republic of China
Zhaoyang Yang
Affiliation:
College of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350000, People’s Republic of China
Candong Li
Affiliation:
College of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350000, People’s Republic of China
*
Corresponding author: Shujie Xia; Email: xiashujie121@126.com
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Abstracts

This study systematically evaluates the effects of probiotic interventions on gut microbiota and clinical outcomes in diabetic patients to determine the optimal target population and conditions for effective use, with an emphasis on precision treatment. A comprehensive search was performed across PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Internet (CNKI), and Wanfang databases until April 2024. Randomized controlled trials (RCTs) assessing probiotics as adjunctive therapy for diabetes were included. The control group received standard care, and the intervention group received probiotics alongside standard care. Data were managed with Endnote and Excel, and analyses were conducted using Revman 5.3 and Stata 16. Twelve RCTs involving 1113 participants were included. Probiotics significantly increased fecal Lactobacillus (standardized mean difference (SMD) 1.42, P < 0.0001, I2 = 95 %) and Bifidobacterium levels (SMD 1.27, P < 0.0001, I2; = 90 %) and reduced fasting plasma glucose (SMD −0.35, P = 0.004). Subgroup analysis showed that shorter intervention durations (≤ 3 months) improved FPG, HbA1c, and Bifidobacterium levels, while younger patients (≤ 60 years) experienced the most significant improvements in Bifidobacterium levels. In conclusion, probiotics improve gut microbiota and clinical outcomes in diabetic patients, with intervention duration and patient age as key factors influencing treatment effectiveness.

Keywords

ProbioticsGastrointestinal microbiomeDiabetes/prediabetesMeta-analysis

Information

Type
Systematic Review and Meta-Analysis
Information
British Journal of Nutrition , Volume 135 , Issue 4 , 28 February 2026 , pp. 387 - 398
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Nutrition Society

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Footnotes

Lifen Hong and Yan Zheng contributed equally to this work.

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