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Du Y, Neng Q, Li Y, Kang Y, Guo L, Huang X, Chen M, Yang F, Hong J, Zhou S, Zhao J, Yu F, Su H, Kong X. Gastrointestinal Autonomic Neuropathy Exacerbates Gut Microbiota Dysbiosis in Adult Patients With Type 2 Diabetes Mellitus. Front Cell Infect Microbiol 2021; 11:804733. [PMID: 35211420 PMCID: PMC8861497 DOI: 10.3389/fcimb.2021.804733] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/17/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The diabetic autonomic neuropathy is one of the most common complications in type 2 diabetes mellitus (T2DM), especially gastrointestinal autonomic neuropathy (GAN), which occurs in up to 75% of patients. The study aimed to investigate the gut microbiota composition, structure, and function in T2DM patients with GAN (T2DM_GAN) and set up a link between gut microbiota and clinical characteristics of patients. METHODS DNA was extracted from fecal samples of three groups using the kit method: healthy volunteers (n = 19), the patients with T2DM (n = 76), and T2DM_GAN (n = 27). Sequencing of 16S ribosomal DNA was performed using the MiSeq platform. RESULTS According to the clinical data, higher age, lower triglyceride, and lower body mass index were the main features of patients with T2DM_GAN. The gut microbiota analysis showed that Bacteroidetes, Firmicutes, and Proteobacteria constituted the three dominant phyla in healthy individuals. In addition, the gut microbiota structure and function of T2DM_GAN patients were clearly different from that of T2DM patients. T2DM patients were characterized by Fusobacteria, Fusobacteriia, Fusobacteriales, Fusobacteriaceae, Fusobacterium, Lachnoclostridium, and Fusobacterium_mortiferum. Those gut microbiota may be involved in carotenoid and flavonoid biosyntheses. Relatively, the Gammaproteobacteria, Enterobacteriales, Enterobacteriaceae, Escherichia-Shigella, Megasphaera, Escherichia_coli, and Megasphaera_elsdenii were characteristic in the T2DM_GAN patients. Those may be involved in bacterial invasion of epithelial cells and pathogenic Escherichia coli infection. CONCLUSIONS GAN exacerbated gut microbiota dysbiosis in adult patients with T2DM. The findings indicated that phyla Fusobacteria and class Gammaproteobacteria were closely related to the occurrence of T2DM. Especially the latter may promote T2DM_GAN.
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Affiliation(s)
- Yuhui Du
- Medical Faculty, Kunming University of Science and Technology, Kunming, China
- Endocrinology Branch, The First People’s Hospital of Yunnan Province, Kunming, China
- School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Qiongli Neng
- Endocrinology Branch, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Yu Li
- Medical Faculty, Kunming University of Science and Technology, Kunming, China
- School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Yongbo Kang
- School of Basic Medical Sciences, Shanxi Medical University, Taiyuan, China
- *Correspondence: Xiangyang Kong, ; Heng Su, ; Yongbo Kang,
| | - Liqiong Guo
- Medical Faculty, Kunming University of Science and Technology, Kunming, China
| | - Xinwei Huang
- Medical Faculty, Kunming University of Science and Technology, Kunming, China
| | - Minghui Chen
- Medical Faculty, Kunming University of Science and Technology, Kunming, China
| | - Fan Yang
- Nutrition Department, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Jingan Hong
- Nutrition Department, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Shuai Zhou
- Neurosurgery Department, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Jianhua Zhao
- Neurosurgery Department, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Fubing Yu
- Digestive System Department, Affiliated Hospital of Yunnan University, Kunming, China
| | - Heng Su
- Endocrinology Branch, The First People’s Hospital of Yunnan Province, Kunming, China
- *Correspondence: Xiangyang Kong, ; Heng Su, ; Yongbo Kang,
| | - Xiangyang Kong
- Medical Faculty, Kunming University of Science and Technology, Kunming, China
- *Correspondence: Xiangyang Kong, ; Heng Su, ; Yongbo Kang,
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Kempler P, Amarenco G, Freeman R, Frontoni S, Horowitz M, Stevens M, Low P, Pop-Busui R, Tahrani AA, Tesfaye S, Várkonyi T, Ziegler D, Valensi P. Management strategies for gastrointestinal, erectile, bladder, and sudomotor dysfunction in patients with diabetes. Diabetes Metab Res Rev 2011; 27:665-77. [PMID: 21748841 DOI: 10.1002/dmrr.1223] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 06/06/2011] [Indexed: 02/06/2023]
Abstract
There are substantial advances in understanding disordered gastrointestinal autonomic dysfunction in diabetes. It occurs frequently. The underlying pathogenesis is complex involving defects in multiple interacting cell types of the myenteric plexus as well. These defects may be irreversible or reversible. Gastrointestinal symptoms represent a major and generally underestimated source of morbidity for escalating health care costs in diabetes. Acute changes in glycaemia are both determinants and consequences of altered gastrointestinal motility. 35-90% of diabetic men have moderate-to-severe erectile dysfunction (ED). ED shares common risk factors with CVD. Diagnosis is based on medical/sexual history, including validated questionnaires. Physical examination and laboratory testing must be tailored to patient's complaints and risk factors. Treatment is based on PDE5-inhibitors (PDE5-I). Other explorations may be useful in patients who do not respond to PDE5-I. Patients at high cardiovascular risk should be stabilized by their cardiologists before sexual activity is considered or ED treatment is recommended. Estimates on bladder dysfunction prevalence are 43-87% of type 1 and 25% of type 2 diabetic patients, respectively. Common symptoms include dysuria, frequency, urgency, nocturia and incomplete bladder emptying. Diagnosis should use validated questionnaire for lower urinary tract symptoms. The type of bladder dysfunction is readily characterized with complete urodynamic testing. Sudomotor dysfunction is a cause of dry skin and is associated with foot ulcerations. Sudomotor function can be assessed by thermoregulatory sweat testing, quantitative sudomotor axon reflex test, sympathetic skin response, quantitative direct/indirect axon reflex testing and the indicator plaster.
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Affiliation(s)
- P Kempler
- I Department of Medicine, Semmelweis University, Budapest, Hungary.
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