Gut–Bile Acid Cross-Talk: Can a Multi-Strain Probiotic Rescue Metformin Intolerance?

Probiotic Pathways to Better Metformin Tolerance Metformin remains first-line therapy for T2D , yet gastrointestinal intolerance frequently limits dose escalation and long-term adherence, especially in people with obesity and established intolerance. Building on the ProGasMet randomized, double-blind, placebo-controlled cross-over trial, this post-hoc multi-omics analysis focused on the first 12‑week treatment period in 34 adults with type 2 diabetes and documented metformin intolerance (17 probiotic, 17 placebo), integrating shotgun metagenomics, gut metabolic modules, and untargeted faecal LC‑MS metabolomics from paired baseline and week‑12 stool samples.

Using DIABLO multi-block sparse PLS and covariate‑adjusted mixed models, the investigators found no major differences in alpha diversity or global community turnover between groups, but identified a coordinated, modest shift in…