Role of microbiota in development of type 2 diabetes mellitus: pathogenesis and treatment landscape

The gut microbiota is a complex of microorganisms, mainly bacteria, inhabiting the human intestines. Microorganisms of the intestinal microflora influence metabolism, immunological reactivity, and pathogenesis of various diseases, such as diabetes mellitus, obesity, inflammatory bowel diseases, and others. This article examines the influence of intestinal microflora on the development of type 2 diabetes mellitus and its treatment options. A review of publications shows that microbiota imbalance may be associated with various metabolic disorders, which is confirmed by many studies. Active metabolites affecting the development of type 2 diabetes mellitus include short-chain fatty acids, imidazole propionate, trimethylamine N-oxide, branched-chain amino acids, and tryptophan metabolites. These compounds can affect the metabolic processes in the body, including insulin sensitivity, inflammatory reactions, and glucose metabolism, which may eventually contribute to the development of type 2 diabetes mellitus. Studying the interaction of the gut microbiota with drugs is challenging as the underlying biological mechanisms are not fully understood. The key discussed aspects also include the contemporary treatment landscape of type 2 diabetes mellitus associated with the microbiome, namely the use of metformin as a sugar-lowering drug; the use of pro- and prebiotics; dietary and lifestyle interventions; fecal microbiota transplantation, and smoking cessation. All these treatment options show ability in controlling microbiota to manage the disease and improve therapy outcomes. Further research in this area opens up opportunities for the development of innovative treatment strategies for type 2 diabetes mellitus focused on the health of the intestinal microflora. Understanding the impact of microbiota on metabolic disorders will help to develop personalized treatment approaches and lead to improved health in patients with type 2 diabetes mellitus.