Furthermore, as intestinal permeability is higher in T1DM and is accompanied by increased serum pro-inflammatory cytokines and LPS,27 probiotics may have intestinal modulation and regulation of pro-inflammatory cytokines as a mechanism of action.28 Therefore, their supplementation could be beneficial as they increase insulin sensitivity and reduce the autoimmune response.29 Two studies did not find an association of probiotics or similar with a decrease in the total daily required insulin dosage and one study found a higher insulin dose in the probiotic group. This evidence concerns the gene INS and type 1 diabetes mellitus.