{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T18:57:19Z","timestamp":1792090639289,"version":"4.4.0"},"reference-count":169,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T00:00:00Z","timestamp":1766793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder influenced not only by genetics, diet, and lifestyle but also by the gut microbiota. Dysbiosis (imbalances in microbial composition) can disrupt gut barrier integrity, alter microbial metabolites, and trigger low-grade inflammation, contributing to insulin resistance and \u03b2-cell dysfunction. Nutritional interventions, such as probiotics, prebiotics, synbiotics, postbiotics, and bioactive food components, represent potential therapeutic approaches for ameliorating gut eubiosis and advancing glycemic regulation. This narrative review incorporates evidence from selected studies identified by searches in PubMed, Scopus, and Google Scholar for studies published up to November 2025. The methodology included a structured literature search of in vitro, animal, and human studies, with a focus on intervention trials and mechanistic research. There are many positive signals from randomized controlled trials (RCTs), but heterogeneity and short follow-up limit definitive recommendations. Evidence from clinical and experimental studies indicates a beneficial effect on fasting glucose, hemoglobin A1c, and inflammatory markers, though heterogeneity of the individual and the variability in study designs limit generalization. There is insufficient evidence to recommend microbiota modulation as standard therapy in any disease. Key knowledge gaps include standardized interventions, stratified analyses by medication use (e.g., metformin), clinically meaningful endpoints, and long-term safety data. This review summarizes current knowledge on gut microbiota-driven mechanisms in T2DM and evaluates emerging microbiota-targeted therapies as adjunctive strategies for metabolic improvement.<\/jats:p>","DOI":"10.3390\/nu18010089","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T08:47:27Z","timestamp":1766998047000},"page":"89","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Modulating the Gut Microbiome in Type 2 Diabetes: Nutritional and Therapeutic Strategies"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6271-5595","authenticated-orcid":false,"given":"Christos G.","family":"Nikolaidis","sequence":"first","affiliation":[{"name":"Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, \u2018AHEPA\u2019 University General Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"},{"name":"2nd Department of Medicine, Hippokration Hospital, National and Kapodistrian University of Athens, 14564 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5439-2149","authenticated-orcid":false,"given":"Despoina","family":"Gyriki","sequence":"additional","affiliation":[{"name":"Hepatogastroenterology Unit, Academic Department of Internal Medicine, General Oncology Hospital of Kifissia \u201cAgioi Anargyroi\u201d, National and Kapodistrian University of Athens, 14564 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8299-9035","authenticated-orcid":false,"given":"Elisavet","family":"Stavropoulou","sequence":"additional","affiliation":[{"name":"Master Program in \u201cFood, Nutrition and Microbiome\u201d, Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"},{"name":"Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, University of Lausanne, 1015 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7094-0338","authenticated-orcid":false,"given":"Eleni","family":"Karlafti","sequence":"additional","affiliation":[{"name":"Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, \u2018AHEPA\u2019 University General Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0236-8760","authenticated-orcid":false,"given":"Triantafyllos","family":"Didangelos","sequence":"additional","affiliation":[{"name":"Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, \u2018AHEPA\u2019 University General Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7869-6824","authenticated-orcid":false,"given":"Christina","family":"Tsigalou","sequence":"additional","affiliation":[{"name":"Master Program in \u201cFood, Nutrition and Microbiome\u201d, Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"},{"name":"Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2902-8053","authenticated-orcid":false,"given":"Anastasia","family":"Thanopoulou","sequence":"additional","affiliation":[{"name":"2nd Department of Medicine, Hippokration Hospital, National and Kapodistrian University of Athens, 14564 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.1016\/S0140-6736(22)01655-5","article-title":"Type 2 Diabetes","volume":"400","author":"Ahmad","year":"2022","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"M\u0142ynarska, E., Wasiak, J., Gajewska, A., Ste\u0107, G., Jasi\u0144ska, J., Rysz, J., and Franczyk, B. 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