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The Role of The Gut Microbiome in Diabetes Management

Rebecca Jaspan, MPH, RD, CDN, CDCES


For decades, management of type 2 diabetes has largely been approached through lifestyle changes and medication.  New research is pointing to another deeper issue related to the root causes of diabetes: the gut microbiome.  The bacteria in your gut are important for maintaining digestive health, supporting the immune system, and improving mental health.  They also contribute to the body’s blood sugar metabolism and may help prevent and manage diabetes.  So, what’s the link between the gut microbiome and diabetes?  Read on to learn more about how this relationship works.


When the body is functioning normally, the carbohydrates that we eat break down into sugar which triggers insulin release from our pancreas.  The insulin moves the sugar from the blood into the cells to be used for energy.


In order for our gut to stay healthy, it needs a diverse species of gut bacteria and a high fiber diet known as prebiotics to act as fuel for the gut bacteria.  Our gut bacteria produce short-chain fatty acids, which help to produce hormones and improve our body’s response to blood sugar and the effects of insulin. The number and type of gut bacteria directly influence the production of short-chain fatty acids.  If an inflammatory disease, such as diabetes, or a low fiber diet disrupts the diversity in the gut, it will decrease production of short-chain fatty acids.  Fewer short-chain fatty acids results in a poorer insulin response, leading to insulin resistance and a greater chance of developing or worsening diabetes symptoms.1  Not only will fewer short-chain fatty acids be produced, but the gut will produce harmful inflammatory metabolites instead.  Inflammation in diabetes leads to less insulin production by the pancreas and inflammation in other cells leads to a weaker insulin response and inefficient use of blood sugar.


The good news is that type 2 diabetes is very responsive to improvements in gut health.  Implementing a higher fiber diet can help prevent and improve symptoms of diabetes.  Eating more fiber from whole grains, legumes, fruits, and vegetables provides healthy gut bacteria with the fuel they need to produce plenty of short chain fatty acids and thus regulate blood sugar, and reduce inflammation.


Additionally, fermented foods are packed with probiotics, beneficial bacteria for the gut, and add flavor and variety to your diet.  Fermented foods include pickled vegetables, sauerkraut, kimchi, yogurt, kefir, kombucha, and miso.  One study found that vinegar, used to ferment pickled foods, can help increase your cells’ insulin response.2


New research is also pointing to the use of taking probiotic supplements to manage insulin resistance and diabetes.  Many studies support the role of probiotics for diabetes in blood sugar management, heart health, gut health, which are all areas critical to diabetes management.  While taking a probiotic won’t directly lower blood sugar, research suggests that a probiotic supplement can help lower insulin and glucose levels in the bloodstream overtime.  When choosing a probiotic, the specific strain contained in the supplement is important.  You also want to look for at least 1 billion CFUs, or colony forming units.  For diabetes and prediabetes, some studies have shown Lactobacillus casei and Lactobacillus rhamnosus have a modest effect on glucose metabolism.3


Akkermansia muciniphila is another strain that has gotten attention in over 1,000 publications for its role in diabetes and gut health.4  This strain has been found to be much less common in the microbiome samples taken from individuals with type 2 diabetes, suggesting that not having enough of this type of bacteria species may lead to insulin resistance and poorly controlled blood sugar.  Studies show that individuals with diabetes taking Akkermansia muciniphila and metformin have lower blood glucose spikes by 32.5% and reduced HgA1C levels by .6%.5


Research on gut health and diabetes and growing and evolving all of the time.  Have questions about gut health, inflammation, and blood sugar control?  Be sure to ask your LCWNS dietitian for guidance on nutrition and supplement recommendations that best meet your individual needs and goals.













  1. Gurung M, Li Z, You H, et al. Role of gut microbiota in type 2 diabetes pathophysiology. EBioMedicine. 2020;51:102590. doi:10.1016/j.ebiom.2019.11.051
  2. Mitrou P, Petsiou E, Papakonstantinou E, et al. Vinegar Consumption Increases Insulin-Stimulated Glucose Uptake by the Forearm Muscle in Humans with Type 2 Diabetes. J Diabetes Res. 2015;2015:175204. doi:10.1155/2015/175204
  3. Li Y, Wu Y, Wu L, Qin L, Liu T. The effects of probiotic administration on patients with prediabetes: a meta-analysis and systematic review. J Transl Med. 2022;20(1):498. Published 2022 Nov 2. doi:10.1186/s12967-022-03695-y
  4. Zhang T, Li Q, Cheng L, Buch H, Zhang F. Akkermansia muciniphila is a promising probiotic. Microb Biotechnol. 2019;12(6):1109-1125. doi:10.1111/1751-7915.13410
  5. Vallianou NG, Stratigou T, Tsagarakis S. Metformin and gut microbiota: their interactions and their impact on diabetes. Hormones (Athens). 2019;18(2):141-144. doi:10.1007/s42000-019-00093-w


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