Meta-Analysis
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Exp Med. Sep 20, 2025; 15(3): 108467
Published online Sep 20, 2025. doi: 10.5493/wjem.v15.i3.108467
Triple probiotic combination effect on metabolic, oxidative stress, and inflammatory parameters in diabetic population: Systematic review and meta-analysis
Vishal P Dubey, Jignesh J Kansagra, Bhargav K Kamani, Varun P Sureja
Vishal P Dubey, Jignesh J Kansagra, Bhargav K Kamani, Varun P Sureja, Department of Scientific and Medical Affairs, Sundyota Numandis Probioceuticals Pvt. Ltd., Ahmedabad 380015, Gujarat, India
Author contributions: Dubey VP designed the study protocol, acquisition of data, analysis and interpretation of data, drafting and revising the article, final approval; Kansagra JJ acquisition of data, interpretation of data, revising the article, final approval; Kamani BK acquisition of data, interpretation of data, revising the article, final approval; Sureja VP acquisition of data, interpretation of data, revising the article, final approval.
Conflict-of-interest statement: All authors independently declare that they are employees of Sundyota Numandis Probioceuticals Pvt. Ltd. (Ahmedabad, Gujarat, India). The authors declare no other potential competing interests. The employer had no role during the entire study conduct and publication process. The employer has no commercialized product that can be benefitted by the observations of the current study. The current study was conducted as part of the authors’ independent scientific work with no involvement of the employer’s commercial aspect in whatsoever condition. No financial support was received from any commercial/non-commercial organization for the current study.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vishal P Dubey, Researcher, Department of Scientific and Medical Affairs, Sundyota Numandis Probioceuticals Pvt. Ltd., Ahmedabad 380015, Gujarat, India. vishal.d@sundyotanumandis.com
Received: April 15, 2025
Revised: May 16, 2025
Accepted: July 24, 2025
Published online: September 20, 2025
Processing time: 119 Days and 17.5 Hours
Abstract
BACKGROUND

Diabetes is an epidemic condition affecting people globally with a high rate of morbidity and mortality. While various pharmacological and non-pharmacological treatment options are used, diabetes is still a non-treatable condition. Constant attempts are made to identify newer therapies that could support better management of the diabetes condition and improve overall quality of life. Numerous studies have supported the potential role of probiotics therapy in the diabetes condition.

AIM

To evaluate the efficacy of triple probiotic combination on glycaemic, metabolic, oxidative stress, and inflammatory parameters in the diabetic population.

METHODS

Randomized controlled trials evaluating the efficacy of the triple probiotic combination in diabetic patients were identified. The quality of the studies was evaluated using the PEDro scale while biasness between and within the studies was assessed using the Risk of Bias tool. Meta-analysis was conducted using RevMan software, and sensitivity analysis was performed using OpenMeta Analyst software. The study protocol was registered in PROSPERO (CRD42024530999).

RESULTS

Five good-quality clinical trials were included. Low-to-moderate risk of bias was observed. Data from 300 participants were included (150 participants in both groups). Probiotics supplementation significantly improved glycaemic and insulin parameters (glucose level: -23.86 mg/dL; insulin level: -5.02 µIU/mL; HOMA-IR: -1.82 score; QUICKI: +0.02 score; HOMA-B: -16.30 score; P < 0.05 for all parameters), reduced oxidative stress and improved antioxidant parameters [TAC: +92.55 mmol/L; glutathione (GSH): +40.55 μmol/L; nitric oxide (NO): +6.45 μmol/L; malondialdehyde (MDA): -0.48 μmol/L; hs-CRP: -2.24 mg/L; P < 0.05 for all parameters except GSH], and improved lipid parameters (total cholesterol (TC): -3.43 mg/dL; triglycerides (TG): -4.26 mg/dL; low-density lipoprotein: -4.62 mg/dL; very low-density lipoprotein: -0.83 mg/dL; high-density lipoprotein (HDL): +1.83 mg/dL; TC/HDL ratio: -0.25; P < 0.05 for HDL and TC/HDL ratio parameters) compared to the control group.

CONCLUSION

The combination of L. acidophilus, L. casei, and B. bifidum is effective in diabetic patients with cardio/renal complications. Further well-designed studies are warranted to support the results of current research.

Keywords: Diabetes; Probiotics; Glucose; Insulin; Systematic review; Meta-analysis

Core Tip: Diabetes is an endemic condition that has high morbidity and mortality rates. Probiotics are live microorganisms that, when consumed, give healthy benefits to the recipient. The current study evaluated the effect of a triple probiotic combination (Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium bifidum) in the diabetic population by conducting a systematic review and meta-analysis of randomized controlled clinical trials. The results of the current study suggest that the use of this probiotics combination can provide beneficial effects to patients with diabetes.