Effect of probiotics and related supplements on glycemic control in pediatric patients with type 1 diabetes mellitus: a systematic review and meta-analysis of clinical trials.

Abstract

<h4>Objective</h4>Type 1 diabetes mellitus (T1DM) is a common autoimmune disease in children, characterized by the destruction of pancreatic β-cells. Despite treatment advancements, many patients struggle with glycemic control. Recent research suggests the gut microbiome plays a role in T1DM, with dysbiosis contributing to its onset. Probiotics may help improve glycemic control and reduce inflammation, but their effects in children with T1DM are unclear. This study systematically reviews the impact of probiotics and related supplements on glycemic control in pediatric T1DM patients.<h4>Methods</h4>This study adhered to PRISMA guidelines and was registered in PROSPERO (CRD42025633971). We searched databases including PubMed and EMBASE until January 5, 2025. The focus was on randomized controlled trials (RCTs) involving participants under 18 with T1DM, examining the effects of probiotics, prebiotics, and synbiotics on glycemic control indexes like fasting blood glucose (FBG), hemoglobin A1c (HbA1c), C-peptide, and insulin needs. Two researcher extracted data, quality was assessed via the Cochrane Handbook, and STATA 16 was used for statistical analysis.<h4>Results</h4>Eight RCTs with 494 participants (246 intervention, 248 control) showed that probiotics and synbiotics significantly reduced HbA1c levels [Weighted Mean Difference (WMD) = -0.25%, 95% Confidence Interval (CI) = -0.45, -0.04; <i>p</i> = 0.019] with low heterogeneity [I-squared (I²) = 22%]. However, no significant changes were found in FBG, C-peptide levels, or insulin requirements. Sensitivity analyses yielded similar directions of effect for HbA1c. Subgroups suggested larger HbA1c reductions with longer intervention duration, shorter disease duration, and multi-strain formulations.<h4>Conclusion</h4>Probiotic supplementation may achieve a small improvement in HbA1c in pediatric T1DM. Adequate dosing, longer intervention duration, and multi-strain formulations may be more likely to improve HbA1c, but the clinical importance is uncertain. However, our result shows no significant effects on fasting blood glucose, C-peptide, or insulin requirements; no routine clinical recommendations are proposed. The role of probiotics and related supplements in long-term glycemic control still requires confirmation through trials with extended follow-up. Large-scale, rigorously designed studies are needed to determine optimal intervention parameters, clarify underlying mechanisms, and evaluate the clinical applicability of probiotics in T1DM management.<h4>Systematic review registration</h4>identifier [CRD42025633971].