title: The oral microflora in obesity and type-2 diabetes.
abstract: BACKGROUND
  Type 2 diabetes mellitus (T2DM) is prevalent in people with obesity. It has been proposed that these conditions are related to specific features of the microflora of the mouth and lower gastrointestinal (GI) tract. Hyperglycemia often resolves quickly after Roux-en-Y gastric bypass (RYGB) but the role of the GI microflora cannot be examined easily because of reduced intestinal mobility. We propose that the study of microorganisms present in the mouth of patients undergoing RYGB will contribute to our understanding of the role of bacteria in the pathogenesis of T2DM.
  
  
  OBJECTIVE
  To conduct a feasibility study to examine differences in oral microbes in obese patients with and without T2DM and to determine whether it is feasible to measure changes after gastric bypass surgery.
  
  
  METHODS
  Individuals with morbid obesity (n=29), of whom 13 had T2DM, were studied. Oral rinses, stool samples, and blood samples were obtained before RYGB, and oral rinses and blood samples were obtained at 2 and 12 weeks postsurgery.
  
  
  RESULTS
  Prior to surgery, participants with T2DM had slightly higher total levels of oral bacteria than those without diabetes. Those with HbA1c > 6.5% had rather lower levels of Bifidobacteria in the mouth and stool. At 2 weeks post-RYGB, patients with T2DM were able to reduce or discontinue their hypoglycemic medications. Stool samples could not be obtained but oral rinses were readily available. The levels of oral Bifidobacteria had increased tenfold and levels of circulating endotoxin and tumor necrosis factor-alpha had decreased.
  
  
  CONCLUSIONS
  The study of oral bacteria before and after RYGB is feasible and should be tested in larger patient populations to increase our understanding of the role of microorganisms in the pathogenesis of obesity and T2DM.
authors.affiliation: Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Shillitoe
authors.forename: Ruth
authors.initials: R
authors.lastname: Weinstock
authors.forename: Taewan
authors.initials: T
authors.lastname: Kim
authors.forename: Howard
authors.initials: H
authors.lastname: Simon
authors.forename: Jessica
authors.initials: J
authors.lastname: Planer
authors.forename: Susan
authors.initials: S
authors.lastname: Noonan
authors.forename: Robert
authors.initials: R
authors.lastname: Cooney
keywords: Bifidobacteria; gastric bypass; obesity; oral microflora; type-2 diabetes