Ali Bajwa

Cardiometabolic complications related to type 2 diabetes mellitus (T2DM) are often due to changes in the gut microbiota. The review analyzed studies looking at the effects of probiotics, prebiotics, high-fiber diets, and fecal microbiota transplantation (FMT) on glucose levels and heart and metabolic health in individuals either having T2DM or being at risk. The review followed the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. The literature was searched using text terms and controlled vocabulary, employing Boolean operators "AND," "OR," and various combinations across PubMed, Embase, and the Cochrane Library. Open-access, full-text English papers from 2005 to 2025, including those authored by people, were searched. The quality was assessed using the Risk of Bias 2.0 (RoB 2.0) tool, and the evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Fifteen randomized controlled trials (RCTs) were analyzed for methodological quality, with three categorized as having a high risk of bias (RoB). The GRADE tool categorized two high RoB RCTs as "low quality." However, two RCTs had low RoB and were classified as "high quality." Ten RCTs had uncertain RoB, lowering the evidence by one point to "moderate quality." A comprehensive review of RCTs was conducted to assess outcomes related to glycemic parameters (e.g., glycated hemoglobin (HbA1c), fasting glucose), lipid profiles, inflammatory markers, anthropometric measures, and gut microbiota composition. Interventions included probiotic and prebiotic supplementation, high-fiber or Mediterranean-style diets, and FMT. Probiotic yogurt containing Lactobacillus acidophilus and Bifidobacterium lactis significantly improved lipid profiles by reducing low-density lipoprotein cholesterol (LDL-C) and total cholesterol. High-fiber diets consistently lowered fasting blood glucose, HbA1c, triglycerides, and LDL-C while elevating high-density lipoprotein cholesterol (HDL-C) and beneficial short-chain fatty acid (SCFA)-producing bacteria. Anti-inflammatory effects were observed across interventions, notably with probiotics and polyphenol-rich Mediterranean diets, which reduced tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and other inflammatory cytokines. The Green-Mediterranean diet significantly improved weight, insulin resistance, and Framingham risk scores. Novel mechanisms involving SCFAs and bile acid metabolism were also identified as key modulators of host metabolic response. Microbiota-based interventions offer promising avenues for glycemic control and cardiometabolic risk reduction in patients with T2DM.

BackgroundCoronary artery disease (CAD) is one of the major causes of mortality around the globe. This study aimed to determine the relationship between hemoglobin (Hb) levels and CAD severity in patients with myocardial infarction (MI).MethodologyThis retrospective study was conducted among 265 MI patients at Jinnah Hospital’s Cardiology Unit, Lahore, Pakistan, between March 2022 and March 2023. Consecutive sampling and predefined criteria guided patient enrollment. A predefined proforma collected patient data from the medical record, which was then categorized into non-severe CAD and severe CAD groups based on Gensini scores. Independent t-tests and chi-square tests were used to compare variables between the groups. Pearson’s correlation coefficient determined the Hb level and CAD severity relationship, while linear regression analysis assessed the Hb level’s predictive value for CAD severity. A p-value <0.05 indicated statistical significance. Data analysis was performed using SPSS software, version 25 (Released 2017; IBM Corp., Armonk, NY, USA).ResultsOf 265 patients, 170 (64.15%) had non-severe CAD and 95 (35.85%) had severe CAD. The frequency of anemia was also high (n = 142, 53.58%) in the study population. Patients with severe CAD had significantly lower Hb levels (10.12 ± 3.42 g/dL) compared to those with non-severe CAD (12.89 ± 1.90 g/dL). Significant differences were noted in Gensini scores (p < 0.001) and Hb levels (p < 0.001) between the study groups. A strong negative correlation was noted between Hb levels and CAD severity (r = -0.72, 95% confidence interval (CI) = -0.76 to -0.70, p = 0.001). Regression analysis validated Hb level as a significant determinant of CAD severity (negative unstandardized coefficient = -3.10, standardized coefficient = -0.72, 95% CI = -4.90 to -1.50, p = 0.001, R² = 0.46).ConclusionsThis study presented a significant inverse association between Hb levels and CAD severity in MI patients. Lower Hb levels were correlated with more severe CAD, suggesting its potential as a risk marker and clinical instrument for identifying high-risk patients, facilitating prompt interventions, and guiding therapy.