Disturbance of gut microbiota in diabetic macroangiopathy: Evidence from the gut bacteriome and mycobiome

Diabetic macroangiopathy (DM) is serious complications for individuals with type 2 diabetes (T2D), affecting both their quality of life and survival. Although the role of gut microbiota in T2D is increasingly acknowledged, the association between gut microbiota and DM remains uncertain. This cross-sectional study examines the composition of the gut microbiota, including bacteria and fungi, in 179 participants, comprising 58 T2D patients with DM, 71 T2D patients without DM, and 50 healthy controls. The gut microbiome of individuals with DM exhibited reduced alpha diversity (as indicated by Shannon and Chao1 P < 0.05) and a distinct overall microbial composition compared to healthy controls (P = 0.001). Disruptions in transkingdom interactions between gut bacteria and fungi were observed in individuals with DM, suggesting potential ecosystem disruption. Random forest (RF) models identified gut microbiota markers with significant discriminatory power for distinguishing DM from both T2D and healthy controls. Fungal markers exhibited excellent performance, achieving an average area under the curve (AUC) of 80.67%. Furthermore, their performance significantly increased to an average AUC of 88.45% when combined with bacterial markers. Bacterial markers also demonstrated excellent performance, with an average AUC of 93.67%. Our study establishes compositional alterations of gut microbiome in DM and suggests the potential for using gut microbiota as noninvasive biomarkers to assess disease activity. We gain knowledge and insight into the microbiome alterations in DM, opening new avenues for therapeutic approaches to reshape the human microbiome towards a healthy status.