Medically reviewed by Onikepe Adegbola, MD, PhD
A recent study published by the National Library of Medicine, and conducted by Xin Feng and Xiao-Qing Li, suggests that diabetes is a predisposing factor to small intestinal bacterial overgrowth (SIBO). The study, “The prevalence of small intestinal bacterial overgrowth in diabetes mellitus: a systematic review and meta-analysis” was published in Aging US.
SIBO, which is often misdiagnosed and not well understood by the medical community, is a disease that occurs when an excessive number of bacteria grow in the small intestine. Symptoms include bloating, diarrhea, and weight loss.
The researchers conducted the study to see how common SIBO was in patients with diabetes and what relationship, if any, there was between diabetes and SIBO. They obtained the relevant data from the PubMed, EMBASE, and Cochrane medical databases. Feng and Li searched for any studies related to SIBO and diabetes dating from the start of the databases to June 2021. They conducted 14 studies with 1417 patients with diabetes and 649 control patients.
Among the 1417 people, twenty-nine percent tested positive for SIBO and had a 2.91 higher risk of contracting SIBO than patients without diabetes. The study denotes that the risk would be much higher, in fact, more like 4.18, if the meta-analysis excluded another study, “Small intestinal bacterial overgrowth in adult patients with type 1 diabetes: its prevalence and relationship with metabolic control and the presence of chronic complications of the disease” by Adamska published in the Polish Archives of Internal Medicine. This other study included hospital relatives, and Feng and Li believe that the inclusion of the relatives offsets the control numbers as they relate to the risk factors for SIBO.
Diabetes was determined to be a predisposing factor for SIBO, especially among the patients diagnosed using jejunal aspirate culture (JAC), which is a minor surgical procedure where a physician gets a sample of fluid from a patient’s jejunum (the second part of the small intestine between the duodenum and ileum) and places it onto a cell culture dish for testing. Also, Western countries showed a higher prevalence of SIBO among diabetes patients than Eastern countries, but the type of diabetes the patients had (Type 1 or 2) didn’t make a significant difference in the prevalence of SIBO.
So, what is the big picture here? Well, if we follow some other SIBO studies that researchers have conducted as it relates to other diseases, such as multiple sclerosis (MS), Parkinson’s, and Crohn’s disease, such as the study, “Association of small intestinal bacterial overgrowth with Parkinson’s disease: a systematic review and meta-analysis” published in Gut Pathogens, we start to notice a pattern. SIBO is often being diagnosed as other diseases or disorders, or not being treated at all.
With proper antibiotic administration, most cases of SIBO recover quickly and the bacterium in the small intestine reduces to its normal capacity. However, as long as SIBO continues to be misdiagnosed or not diagnosed at all, then it will continue to thrive in diabetic and other disease communities alike.
Anatomy of the Small Intestine. (2020, August 14). https://med.libretexts.org/@go/page/8056
Dukowicz, A. C., Lacy, B. E., & Levine, G. M. (2007). Small intestinal bacterial overgrowth: a comprehensive review. Gastroenterology & hepatology, 3(2), 112–122.
Feng, X., & Li, X. Q. (2022). The prevalence of small intestinal bacterial overgrowth in diabetes mellitus: a systematic review and meta-analysis. Aging, 14(2), 975–988. https://doi.org/10.18632/aging.203854
Li, X., Feng, X., Jiang, Z., & Jiang, Z. (2021, April 16). Association of small intestinal bacterial overgrowth with parkinson’s disease: A systematic review and meta-analysis – gut pathogens. BioMed Central. Retrieved April 26, 2022, from https://gutpathogens.biomedcentral.com/articles/10.1186/s13099-021-00420-w