Diabetic gastroenteropathy is driven by microbiota-ENS axis dysfunction involving GLP-1, ghrelin, VIP, and nitric oxide signaling, with probiotics, prebiotics, and FMT showing therapeutic potential through ENS repair.
Microbiota-ENS-peptide axisDiabetic GI dysfunction is driven by microbiome-enteric nervous system crosstalk through GLP-1, ghrelin, and VIP peptide signaling—opening microbiome-targeted therapies
What the researchers found
DGE driven by ENS impairment (not just vagus). Microbiota-ENS axis: SCFAs, bile acids, tryptophan. Peptide mediators: GLP-1, ghrelin, VIP, acetylcholine, NO. Microbiome therapies (probiotics, prebiotics, FMT): repair ENS + alleviate DGE. >50% of diabetics have GI symptoms.
Why it matters
Over half of diabetic patients have GI symptoms that worsen glucose control. Understanding the microbiota-ENS-peptide axis reveals new therapeutic targets beyond traditional motility drugs.
How the study worked
Narrative review of microbiota-ENS interactions in diabetic gastroenteropathy with focus on neuropeptide mediators.
What this study cannot tell us
Narrative review. Most microbiome-ENS evidence is preclinical. FMT evidence in diabetic GI dysfunction is limited. Peptide mediator contributions not quantified.
How to read the evidence
Narrative review synthesizing preclinical and early clinical evidence. Strong conceptual framework.
When this study was published
Published in 2025.
The bigger picture
This positions the gut microbiome as the upstream driver of diabetic GI dysfunction, with neuropeptides as the mediators. Microbiome therapies targeting peptide signaling could address a major source of diabetic morbidity.
Questions still open
- Could combining GLP-1 drugs with probiotics improve DGE more than either alone?
- Which specific microbiota species are most important for ENS maintenance?
- Does GLP-1 drug-induced GI slowing worsen or improve DGE?
Common questions
Why do diabetics have stomach problems?
Could probiotics help diabetic stomach problems?
Read the original research
Microbiota and enteric nervous system crosstalk in diabetic gastroenteropathy: bridging mechanistic insights to microbiome-based therapies.
Frontiers in cellular and infection microbiology, 15, 1603442
Citation
Tao, Wang; Yu, Yunfeng; Tan, Danni; Huang, Xiangning; Huang, Jiawang; Lin, Chuanquan; Yu, Rong. (2025). Microbiota and enteric nervous system crosstalk in diabetic gastroenteropathy: bridging mechanistic insights to microbiome-based therapies.. Frontiers in cellular and infection microbiology, 15, 1603442. https://doi.org/10.3389/fcimb.2025.1603442