The prevalence of small intestinal bacterial overgrowth in diabetes mellitus: a systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of non-randomized observational/case-control studies
PubMed 35086065 · doi:10.18632/aging.203854
What was done
Systematic review and meta-analysis of studies in PubMed, Cochrane Library, and EMBASE up to June 2021 examining small intestinal bacterial overgrowth (SIBO) in diabetes mellitus. The authors pooled SIBO prevalence in diabetic cohorts, evaluated the odds ratio compared to non-diabetic controls, and conducted subgroup analyses by diagnostic modality, geographic region, and diabetes type.
What was found
Across 14 studies (1,417 diabetic patients, 649 controls), the pooled prevalence of SIBO in diabetes was 29% (95% CI 20% to 39%). The odds ratio of SIBO in diabetic patients compared with controls was 2.91 (95% CI 0.82 to 10.32, p = 0.10). SIBO prevalence was 39% (95% CI 12% to 66%) by jejunal aspirate culture, 31% (95% CI 18% to 43%) by lactulose breath test, and 29% (95% CI 14% to 43%) by glucose breath test. Prevalence was 35% (95% CI 21% to 49%) in Western countries versus 24% (95% CI 14% to 34%) in Eastern countries, with no significant difference between type 1 (25%, 95% CI 14% to 36%) and type 2 diabetes (30%, 95% CI 13% to 47%).
Why it matters
Provides a pooled estimate indicating that nearly 30% of patients with diabetes test positive for SIBO, though the comparative risk elevation relative to non-diabetic controls did not reach statistical significance.
Limits
The odds ratio comparison against controls had wide confidence intervals and was not statistically significant (p = 0.10). Included studies relied on diagnostic methods with heterogeneous test characteristics. The abstract reports no data on patient-level confounders such as glycemic control, disease duration, autonomic neuropathy, or gastrointestinal medication use.
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