Metformin – a Misunderstood Drug?

A new study suggests scientists may have misunderstood how the drug works in the human body.



Metformin may be one of the most widely used drugs in the 21st century. Now, a new study seems to indicate it’s also one of the most misunderstood.

Since metformin hit the UK market more than half a century ago, clinicians have worked under the premise that the drug works primarily in the bloodstream. Metformin is considered a wonder drug for its ability to suppress glucose production in the liver and increase insulin sensitivity in tissue, but how the drug does this has been debated for years.

Recently, however, a research team working on an experimental delayed-release metformin found evidence that the drug works primarily in the gut rather than in the circulatory system. Dr. John Buse of the University of North Carolina Medical School, the study’s lead author, writes in Diabetes Care that the drug’s interaction with digestive tract endocrine cells appears to trigger a reaction which was previously thought to have taken place primarily in the bloodstream.

While this may upend half a century of understanding of how the drug works, it may also expand the already long list of who can use metformin. The findings may be particularly good news for those with diabetes who have impaired kidney function or who are susceptible to a fatal buildup of lactic acid with metformin use, according to the research team’s report. That’s important, as the drug has become well established as the first medicinal tool in the toolbox to regulate blood sugar levels in prediabetes and Type 2 diabetes.

Of course, such initial findings will need to be fleshed out before warnings are lifted against metformin’s use for some with Type 2 diabetes.

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Jim Cahill is a senior writer for Insulin Nation and Type 2 Nation. Before turning to writing, he was a lawyer in government and private practice who focused on consumer protection and regulatory law. He can be contacted at jcahill@epscomm.com.