World Health Organization in 2002 defined probiotics as “living organisms in food and functional foods”, when ingested may promote host health beyond their inherent basal nutrient content [1]. The Gut Microbiome (GM) plays a role in the development and progression of type 1 and type 2 diabetes and its complications. Disturbances in gut biology contribute to the pathogenesis of DM. GM has been shown to affect drug effectiveness. such as prebiotics, probiotics and synbiotics, may improve glycemic control as well as DM-related metabolic profiles. There is preliminary evidence that it may even help treat the cardiovascular, ophthalmic, neurological, and renal complications of DM and even aid in the prevention of DM. Larger studies is needed before gut probiotics are widely used in clinical practice as an adjunct to current diabetes management [2]. The role of the gut microbiota in the management of diabetes has been demonstrated. Several ongoing trials are investigating the effects of probiotics and prebiotics, widely used to modulate the gut microbiome, on inflammatory factors and biomarkers induced by oxidative stress in patients with diabetes; however, their findings are controversial. Naturally present in fruits, raw vegetables, dairy products (especially fermented products), they are an integral part of the gut microbiota as a component of the common flora. The main probiotic microorganisms used in human nutrition are lactic acid bacteria such as Lactobacillus and Bifidobacterium [3,4].

Compared with healthy subjects, patients with chronic inflammatory diseases, particularly Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (SpA), have an altered gut microbiota called is a biological disorder. Biological dysregulation with increased permeability allows cellular or bacterial antigens to interact more readily with the host immune system [5]. This intestinal inflammation is associated with systemic inflammation and may be responsible for the development of several autoimmune diseases and contribute to their exacerbations [6-9].

Evidence from studies in rats and humans has shown that probiotics locally and systemic modulation of the immune system, leading to a reduction in mucosal inflammation and proinflammatory cytokines [10]. They also reduced arthritis in mice [11]. They can reach the immune system of the intestinal lining, persist for a time, and initiate a specific immune response. The interaction between probiotic strains and enterocytes is critical for the controlled production of cytokines and chemokines secreted by epithelial cells. Indeed, it has been shown that some probiotic organisms can modulate the in vitro expression of pro and anti-inflammatory molecules in a strain-dependent manner. Indeed, treatment with certain strains of Lactobacillus reduces intestinal permeability and reduces the severity of arthritis [12, 13]. The effects of probiotics have been well-studied on allergic diseases and Crohn's disease, for which they have not shown any real benefit.

Alterations in the intestinal microbiota can modulate mechanisms involving risk factors for cardiovascular diseases, including dyslipidemias [14]. The ingestion of probiotics is associated with various beneficial effects on human health and modifies the physiological homeostasis of the intestinal flora. Probiotics are microorganisms with some particular characteristics: human origin, safety in human use, bile and acid resistance, survival in the intestine, at least temporary colonization of the human gut, adhesion to the mucosa and bacteriocine production [15].

Beneficial bacteria of probiotics are usually used to protect the host from microorganism [16]. These bacteria are beneficial in the prevention of different types of diarrhea such as antibiotic and traveler's and they play a role in the management of gastritis resulted from Helicobacter pylori. Additionally, the efficacy of probiotics has been shown in the treatment of infectious diarrhea, in IBD, in pouchitis and in food allergy. They can reduce the severity of the symptoms of IBD and of lactose intolerance. As a final point, it has been acknowledged that probiotics play an important role in the prevention of tumor growth and carcinogenesis process [17].

The nutritional benefits of probiotics consist of protective and beneficial effects against certain health problems have been demonstrated in many randomized controlled trials which support the evidence of its advantages, are growing [18]. The evidence for the positive effects of prebiotics to alleviate constipation and treat hepatic encephalopathy has also been shown in numerous studies. In other studies probiotics showed a lower level of proof of efficacy, including prevention of colon cancer, intestinal infection, and the relapse of IBD [19]. There is a high level of evidence for positive effects of some probiotics in the relief of lactose intolerance, antibiotic-associated intestinal disorders and gastroenteritis [20]. Recent studies have suggested preventive properties against intestinal colonization of bad gut microorganism such as Clostridium difficile and Helicobacter pylori [21, 22, 23, and 24].

The aim of the current study was to evaluate the effects of probiotic supplementation on levels of serum C-Reactive Protein (CRP), inflammatory biomarkers TNF-α, fasting plasma glucose (FPG), lipid profile and weight changes in diabetic patients.