ORLANDO, Fla. — Although recent discoveries about human gut microbiome and its relationship to diabetes are promising, a number of hurdles must be overcome before the microbiome’s potential contribution to diabetes prevention or treatment can be realized, according to Robert Ratner, MD, chief scientific and medical officer of the American Diabetes Association.

Currently, the science is associative, Dr Ratner noted.

“We need standardization,” said Dr Ratner, professor of medicine at Georgetown University Medical School and senior research scientist at the MedStar Health Research Institute, Washington, DC. “What bugs are beneficial and what ones are not?”

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He explained that there are many unanswered questions about the role of diet and probiotics. Dr Ratner said studies will need to be conducted that look prospectively at different doses of probiotics.

During a presentation at the American Association of Clinical Endocrinologists (AACE) 25th Annual Scientific & Clinical Congress, Dr Ratner highlighted recent discoveries about the human gut microbiome and its relationship to diabetes. He noted that this area of research is very promising, but it is still early. 

“We are currently at the hypothesis-generating stage, not hypothesis-testing,” said Dr Ratner.

Significant advances have occurred thanks to the advent of gene sequencing methodology, which revolutionized the ability to analyze the gut microbiome with greater precision. However, Dr Ratner said the gut microbiome is a vast ecosystem made up of trillions of bacteria, viruses, and fungi that reside within humans from birth to death. A number of the studies have produced evidence that increasingly suggests the gut microbiome not only influences the development of diabetes, either positively or negatively, but may also hold potential as a way to prevent or treat diabetes.

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Dr Ratner noted that the gut plays an important role in metabolic function. He said specific bacteria in the gastrointestinal tract appear to be related to immune function in type 1 diabetes and to energy metabolism and obesity in type 2 diabetes. Nevertheless, he cautioned that this is only at the stage where the science is “associative”.

Right now, according to Dr Ratner, the goal is to identify the specific components of pathogenic or protective organisms within the microbiome that drive metabolic changes and establish a causal relationship. However, he said the science is not there yet. Part of the challenge lies in the gut microbiome’s dynamic composition, which is constantly changing in response to a person’s diet and environment, such as hygiene and medication use, Dr. Ratner explained. 

Researchers have yet to determine the optimal composition of gut microbiota, if there even is one. Additional challenges include the need for standardized methodologies for study design, sample collection and data analysis. It is hoped that a national microbiome biobank can be established. Dr Ratner noted that there needs to be a significant financial commitment to oversee data collection and helping maintain an infrastructure for this area of research.

“We don’t know how to intervene to make the change,” said Dr Ratner. Even so, it is hoped that will soon change and this avenue of research will open up new ways of treating and preventing diabetes and a host of other illnesses.


  1. Ratner RE. TGS1: Diabetes and the Microbiome. Presented at: AACE 25th Annual Scientific & Clinical Congress; May 25-29, 2016; Orlando, FL.

This article originally appeared on Endocrinology Advisor