Gut-liver axis in diabetes: Mechanisms and therapeutic opportunities

Figure 3 Key mediators of the gut-liver axis in diabetes and insulin resistance. This diagram highlights bidirectional communication between the gut and liver mediated by microbial and host-derived factors. In dysbiosis, microbial metabolites such as trimethylamine-N-oxide and lipopolysaccharides increase gut permeability, enabling translocation of endotoxins into the portal circulation. These signals promote hepatic inflammation and insulin resistance. Conversely, the liver influences gut homeostasis through the secretion of secondary bile acids and fibroblast growth factor 19, which regulate microbial composition and barrier integrity. Short-chain fatty acids also play a protective role, supporting epithelial health and metabolic balance.