Dysbiosis in the Upper Airway and Gut and Altered Urine Metabolome in Malaysian Diabetic Patients

Gut dysbiosis and an increased risk of respiratory infection in type 2 diabetes have been well recognised. However, the relationship between the gut and respiratory pathobionts carriage rate in the Type 2 diabetic Malaysian population is understudied. To address the knowledge gap, we profiled the gut and upper respiratory tract microbial composition, as well as the urine metabolome of 31 type 2 diabetic adults and 14 non-diabetes adults. We showed a higher prevalence of opportunistic upper respiratory tract (URT) pathogens in diabetes patients. A higher abundance of pro-inflammatory bacteria Escherichia coli was detected in the gut of the diabetes subjects. This coincided with the higher levels of sorbitol and taurine in the urine. The former is produced by aldose reductase, an enzyme strongly associated with airway inflammation, while the latter is a substrate for bacterial antioxidants (i.e. H 2 S). Despite a small sample size, our study revealed the potential relationship between the carriage rate of URT pathobionts with the gut microbial and urine metabolomic profiles of diabetes patients.