Precision Microbiome Modulation: Exploring Lactobacillus spp. as A Targeted Strategy for Type 2 Diabetes Management.

PURPOSE OF REVIEW: The International Diabetes Federation projects a prevalence of 783.2 million cases of type 2 diabetes mellitus (T2DM) by 2045. The escalation in healthcare expenditure and adverse effects of current drugs necessitate a clinically effective and low-cost alternative therapeutic option with minimal health complications. Lactobacillus spp., a well-studied gut probiotic has shown promising antidiabetic effects against T2DM in several randomized controlled trials. However, the exact mechanisms of Lactobacillus spp. in regulating the glycaemic profile are not well elucidated, limiting the optimization of probiotic-based interventions. Therefore, this paper aims to explore the various antidiabetic mechanisms of Lactobacillus spp., with a focus on their integration into precision medicine approaches. RECENT FINDINGS: Lactobacillus spp. supplementation alleviates insulin resistance in T2DM by modulating glucose metabolism and transport, exerting anti-inflammatory and anti-oxidative effects as well as restructuring gut microbiota. Lactobacillus spp. also enhance the functional properties of food by increasing the antioxidant capacity and improving glucose metabolism. Despite these promising effects, clinical translation is challenged by strain-specific survivability in the gastrointestinal tract and safety concerns. Thus, leveraging precision medicine via tailoring treatments based on individual microbiome profiles, genetic backgrounds and metabolic phenotype may unravel the full therapeutic potential of targeted Lactobacillus spp. for T2DM treatment. This approach can be reached by integrating multi-omics profiling and artificial intelligence technologies. Lactobacillus spp. may act as adjunctive support in the management T2DM rather than stand-alone therapies in T2DM management, as their efficacy is dependent on appropriate dietary interventions and metabolic context. Altogether, integrating Lactobacillus spp. into personalized treatment frameworks offers a promising avenue for developing more targeted, effective and safe interventions for T2DM.