Metabolic endotoxemia and diabetes mellitus: A systematic review.
Level 3 - non-randomized controlled study
Systematic review of predominantly observational and case-control studies
PubMed 28183445 · doi:10.1016/j.metabol.2016.12.009
What was done
Authors searched PubMed and Scopus for human studies (observational, cross-sectional, case-control, epidemiological, and clinical trials) comparing serum lipopolysaccharide (LPS) or lipopolysaccharide-binding protein (LBP) concentrations between patients with diabetes (T1DM or T2DM) and healthy controls. Two reviewers independently extracted data and assessed study quality.
What was found
Most identified studies reported higher LPS or LBP concentrations in diabetic individuals compared with healthy controls. Mean fasting LPS concentrations were 235.7% higher in T1DM and 66.4% higher in T2DM relative to non-diabetic participants. Advanced complications (such as macroalbuminuria) and disease onset exacerbated endotoxemia. Antidiabetic medications lowered fasting LPS, with rosiglitazone showing greater reduction and insulin showing lower reduction relative to other treatments.
Why it matters
This review links elevated circulating bacterial endotoxins to both major forms of diabetes and suggests that diabetes medications can modulate systemic endotoxemia.
Limits
The abstract does not state the total number of included studies or participant sample sizes. Marked heterogeneity and variability in endotoxemia measurements were present across studies. Key potential confounders including diet, age, medication use, smoking, and obesity could not be fully controlled.
Cited by
- supports Mechanistic research demonstrates that LPS may be a primary trigger in the development of insulin resistance and type 2 diabetes.