Microbiomes and Diabetes: New Emerging Roles in Pathogenesis, Biomarkers, Complications and Therapeutic Perspectives

Abstract

Diabetes mellitus is a complex collection of chronic metabolic illnesses characterised by sustained abnormalities in glucose regulation and linked with significant microvascular and macrovascular morbidity. Growing data suggests that diabetes is not just a disease of host metabolism but also that complex relationships exist between the human microbiome and pathways of metabolism, immunity and endocrinology. Of particular interest has been the gut microbiome because of the effect of microbial communities and their metabolites on intestinal barrier integrity, inflammation, energy metabolism, bile-acid signalling, incretin secretion, and insulin sensitivity. Alterations in the composition and function of gut microbes have been seen in people with Type 2 Diabetes Mellitus (T2DM) including the loss of some short-chain fatty acid-producing organisms and an increase in the number of potentially pro-inflammatory or opportunistic microbes. In addition, antidiabetic treatments, including metformin, can affect the gut microbiota and hence pharmacological treatment is an important confounding factor in microbiome investigations. There is now growing evidence for the role of oral, urine and other microbiomes in diabetes and associated consequences. Dysbiosis in Type 1 Diabetes Mellitus (T1DM) may play a role in intestinal permeability and mucosal immune response, possibly resulting in autoimmune β-cell death. Changes in the microbiome have also been linked to diabetic kidney disease and associated consequences through inflammatory, metabolic and gut-organ-axis pathways. Therapeutic options include dietary modification, probiotics, prebiotics, synbiotics, faecal microbiota transplantation, microbial metabolites, and microbiome-guided precision medicine. However, the large variation among patients and research, and the uncertainty about the causality prevents the fast clinical translation. In this review, we discuss the present state of knowledge regarding microbiomes in diabetes, with an emphasis on biological mechanisms, diagnostic potential, consequences, therapeutic prospects, and objectives for future study.

Keywords: Microbiome; Gut Microbiota; Diabetes Mellitus; Type 2 Diabetes; Type 1 Diabetes; Dysbiosis; Insulin Resistance; Microbial Metabolites; Probiotics; Precision Medicine

Citation

Johnkennedy N, Emenikeh KA, Chidozie NJ. Microbiomes and Diabetes: New Emerging Roles in Pathogenesis, Biomarkers, Complications and Therapeutic Perspectives. WebLog J Immunol. wji.2026.i2503. https://doi.org/10.5281/zenodo.23297985