Triple probiotic combination effect on metabolic, oxidative stress, and inflammatory parameters in diabetic population: Systematic review and meta-analysis

Table 1 PICOS criteria for study determination

Parameter	Description
Population	Adults with diabetes
Intervention	Fixed triple probiotic combination of Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium bifidum (either as single therapy or in combination with other therapies)
Comparator	Either placebo, any standard therapy alone, or any other supplementation other than the fixed triple probiotic combination of Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium bifidum
Outcomes	1 Glycaemic parameters
	a: Serum glucose level
	b: Serum insulin level
	c: Insulin resistance level (HOMA-IR score)
	d: Insulin sensitivity level (QUICKI score)
	e: Pancreatic β-cell functioning (HOMA-B score)
	2 Antioxidant parameters
	a: Total antioxidant capacity level
	b: Glutathione level
	c: Malondialdehyde level
	d: Nitric oxide level
	e: High sensitivity C-reactive protein level
	3 Lipid parameters
	a: Total cholesterol level
	b: Triglycerides level
	c: Low-density lipoprotein level
	d: Very low-density lipoprotein level
	e: High-density lipoprotein level
	f: Total cholesterol/High-density lipoprotein level ratio
Study design	Randomized controlled clinical study
Study questions	1 Is the triple probiotic combination effective in reducing insulin resistance and improving serum glucose and insulin level in patients with diabetes?
	2 Is the triple probiotic combination effective in reducing oxidative stress and improving antioxidant potential in patients with diabetes?
	3 Is the triple probiotic combination effective in improving lipid parameters in patients with diabetes?

HOMA-IR: Homeostatic model assessment for insulin resistance; HOMA-B: Homeostasis model assessment of β-cell function; QUICKI: Quantitative insulin-sensitivity check index.