Response to Comment to the Article “Are There Differences in Gut Microbiome in Patients with Type 2 Diabetes Treated by Metformin or Metformin and Insulin?” [Response To Letter]

Figures & data

Table 1 Pathomechanisms Which through Oral Hypoglycemic Agents, Insulin and Novel-like Insulin Secretagouges Have Influence on the Gut Microbiome^4,5

Agents Used to Treat Diabetes	Pathomechanism Which Influences Gut Microbiome
Biguanides (Metformin)	Improves gut energy metabolism. Increases the production of short-chain fatty acids. Regulates bile acid metabolism. Decreases intestinal inflammation through reduction in lipids absorption and lipopolysaccharides production. Regulates metabolism of metalloproteins or metal transporters.
Dipeptidyl peptidase-4 (DPP-4) inhibitors	Decreases intestinal inflammation through reduction of Toll-like receptor ligands and cytokine expression. Exerts immunomodulatory effects. Increases the production of short-chain fatty acids.
Sodium-dependent glucose transporter-2 (SGLT-2) inhibitors	Increases the production of short-chain fatty acids.
Thiazolidinediones	Improves gut energy metabolism. Decreases intestinal inflammation by the influence on the expression of immune gene markers.
Sulfonylureas	Potential effect on gut energy metabolism.
α-Glucosidase inhibitors	Increases the production of short-chain fatty acids. Regulates bile acid metabolism. Inhibits microbial α-glucosidases.
Glucagon-like peptide-1 (GLP-1) receptor agonists	Improves gut energy metabolism. Increases the production of short-chain fatty acids.
Insulin	Improves gut energy metabolism.

Chávez-Carbajal A, Pizano-Zárate ML, Hernández-Quiroz F, et al. Characterization of the gut microbiota of individuals at different T2D stages reveals a complex relationship with the host. Microorganisms. 2020;8(1):94. doi:10.3390/microorganisms8010094

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