Prevalence of Small Intestinal Bacterial Overgrowth (SIBO) In Type 2 Diabetes Mellitus: A Systematic Review

Abstract Purpose: Gastrointestinal symptoms affect 50-70% of diabetic patients, resulting in a microbiota composition imbalance. Autonomic neuropathy is irreversible, resulting in diabetic enteropathy and sometimes even small intestine bacterial overgrowth (SIBO). SIBO can result in bile acid deconjugation, diarrhea, steatorrhea, vitamin and micronutrient malabsorption, weight loss, mucosal injury, bacterial translocation, and worsened intestinal motility. Carbohydrate malabsorption is related to the pathogenesis of diabetic macrovascular complications. The goal of this study is to find out how prevalent SIBO is in type 2 diabetes patients. Methods: "Small intestinal bacterial overgrowth," "small bowel bacterial overgrowth," “SIBO,” "type 2 diabetes mellitus," and "type 2 DM," are the keywords used. We searched Proquest, CINAHL, SCOPUS, ScienceDirect, PubMed/MEDLINE, and manual searches through world diabetes associations such as ADA, EASD, EFSD, IDF, FASEB, and PERKENI using the keywords. We use the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for bias risk assessment, and for data analysis, we use STATA 16. Results: Six articles covered 1072 type 2 diabetes patients in clinics and hospitals. With a minimum score of 7.42% and a maximum value of 53.85%, 95% CI 9.97-38.86, and an I2 of 97.17%, the pooled prevalence was 24.39% SD 15.31. HbA1c levels were higher (p=0.02) in type 2 DM patients with SIBO, and blood insulin levels were lower (p=0.001) in type 2 DM patients with SIBO. Each study was pretty varied, and there was evidence of publication bias. Assessment of findings based on GRADE is moderate. Conclusion: According to this study, SIBO is present in 24.39% of type 2 diabetes patients. SIBO conditions exacerbate the morbidity of patients with type 2 diabetes, as indicated by lower insulin levels and a higher HbA1c. In type 2 diabetes patients, a hydrogen breath test (HBT) is recommended to be performed regularly, especially in those who have had DM for more than 5 years.