Impacto de la microbiota intestinal en la patogénesis y terapéutica de la diabetes mellitus
DOI:
https://doi.org/10.47196/diab.v60i1.1290Palabras clave:
microbiota intestinal, diabetes mellitus tipo 1 y tipo 2, inflamación de bajo grado, ácidos grasos de cadena corta, triptófano, probióticos, prebióticosResumen
La microbiota intestinal se ha consolidado como un actor clave en la fisiopatología de las enfermedades metabólicas. En esta revisión el objetivo fue abordar específicamente su relación con la patogénesis y terapéutica de la diabetes mellitus (DM). En la DM2, el desbalance del equilibrio de la microbiota intestinal (disbiosis) se asocia con inflamación crónica de bajo grado, resistencia a la insulina y progresión de complicaciones cardiometabólicas. En la DM1, la evidencia señala que la microbiota intestinal podría desempeñar un rol en la pérdida de la tolerancia inmunológica y en la progresión autoinmune.
La producción de metabolitos bioactivos -como los ácidos grasos de cadena corta, los derivados del triptófano y los ácidos biliares- media la conexión entre la microbiota y el metabolismo energético. Además, la microbiota impacta en la farmacodinamia y farmacocinética de agentes antidiabéticos como la metformina, lo que abre la posibilidad de considerarla un biomarcador de respuesta terapéutica.
Aunque la traslación clínica de los hallazgos experimentales aún es incipiente, emergen estrategias prácticas de la modulación de la microbiota intestinal, como el aumento del consumo de fibra dietaria, la incorporación de alimentos fermentados y prebióticos, y la actividad física regular, que favorecen la diversidad microbiana y la producción de metabolitos beneficiosos. El uso de probióticos muestra resultados promisorios en la DM1 y DM2, aunque su inclusión sistemática en guías clínicas aún no está establecida.
Integrar el conocimiento sobre la microbiota intestinal permitirá impulsar nuevas herramientas diagnósticas y terapéuticas que transformen la práctica diabetológica. El reto es avanzar con estudios clínicos robustos que permitan trasladar los hallazgos a intervenciones personalizadas y efectivas para el cuidado de las personas con DM.
Para realizar esta revisión narrativa, la bibliografía se recopiló mediante búsquedas no estructuradas en bases de datos internacionales como PubMed, utilizando combinaciones de términos relacionados con “gut microbiota”, “metabolic diseases”, “low grade inflammation”, “type 1 diabetes”, “type 2 diabetes”, “insulin resistance”, entre otros. Se priorizaron artículos originales y revisiones publicadas en revistas internacionales de la especialidad, con especial énfasis en los avances conceptuales y experimentales de los últimos 5-10 años.
Citas
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Dirección Nacional de Derecho de Autor, Exp. N° 5.333.129. Instituto Nacional de la Propiedad Industrial, Marca «Revista de la Sociedad Argentina de Diabetes - Asociación Civil» N° de concesión 2.605.405 y N° de disposición 1.404/13.
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