A microbiota‐based predictive model for type 2 diabetes remission induced by dietary intervention: From the CORDIOPREV study

Abstract

Dear Editor, Type 2 diabetes is widely considered as a chronic, progressive disease that is a consequence of the seemingly inexorable decline in β-cell function.1 However, recent studies have demonstrated that in the early stages of development, it may be reversible. Indeed, in this regard, primary support derived from patients undergoing bariatric surgery has provided the earliest evidence of type 2 diabetes remission. In fact, the normalization of plasma glucose levels can occur in some patients just days after bariatric surgical intervention, and even before achieving significant weight loss.2 This observation points to a relevant glucoregulatory role of the gastrointestinal tract. It has been proposed that a number of different, but notmutually exclusive, potential mechanisms may contribute toward this effect, including changes in bile acid metabolism, gastrointestinal tract nutrient sensing and glucose utilization, incretins, and gut microbiota.3 Recent studies have shown that it is possible to induce type 2 diabetes remission by weight loss with calorie restriction interventions.4 Depletion of the gut microbiota with antibiotic treatment and fecal microbiota transplantation suggest that the gut microbiota plays a causal role in the beneficial effects of calorie restriction, especially by lowering body weight and hepatic lipid accumulation.5 Furthermore, it has been observed that calorie restriction and diabetes remission are associated with an improvement of gut permeability and a reduction in inflammatory and endotoxemia biomarkers.6,7 Thus, it is noteworthy that the two approaches that, to date, are known to enable type 2 diabetes remission have plausibly suggested that a role is played by the gut microbiota. This idea is further strengthened by the reported association between this disease and the gut microbiota. Alterations in the gut microbiota of patients with type 2 diabetes have been described,8 which adds to the potential causal relationship between the gut microbiome and