Metformin and the gastrointestinal tract

Laura J. McCreight; Clifford J. Bailey; Ewan R. Pearson

doi:10.1007/s00125-015-3844-9

Metformin and the gastrointestinal tract

Laura J. McCreight, Clifford J. Bailey, Ewan R. Pearson (Lead / Corresponding author)

Research output: Contribution to journal › Article › peer-review

518 Citations (Scopus)

257 Downloads (Pure)

Abstract

Metformin is an effective agent with a good safety profile that is widely used as a first-line treatment for type 2 diabetes, yet its mechanisms of action and variability in terms of efficacy and side effects remain poorly understood. Although the liver is recognised as a major site of metformin pharmacodynamics, recent evidence also implicates the gut as an important site of action. Metformin has a number of actions within the gut. It increases intestinal glucose uptake and lactate production, increases GLP-1 concentrations and the bile acid pool within the intestine, and alters the microbiome. A novel delayed-release preparation of metformin has recently been shown to improve glycaemic control to a similar extent to immediate-release metformin, but with less systemic exposure. We believe that metformin response and tolerance is intrinsically linked with the gut. This review examines the passage of metformin through the gut, and how this can affect the efficacy of metformin treatment in the individual, and contribute to the side effects associated with metformin intolerance.

Original language	English
Pages (from-to)	426-435
Number of pages	10
Journal	Diabetologia
Volume	59
Issue number	3
Early online date	16 Jan 2016
DOIs	https://doi.org/10.1007/s00125-015-3844-9
Publication status	Published - Mar 2016

Keywords

Bile acids
DPP-4
GLP-1
Gut/intestine
Lactate
Metformin
Microbiome
OCT1
Review
Serotonin
Uptake

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s00125-015-3844-9Licence: CC BY

Publisher final version
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http:// creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Final published version, 765 KBLicence: CC BY

http://link.springer.com/article/10.1007/s00125-015-3844-9Licence: CC BY

Cite this

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title = "Metformin and the gastrointestinal tract",

abstract = "Metformin is an effective agent with a good safety profile that is widely used as a first-line treatment for type 2 diabetes, yet its mechanisms of action and variability in terms of efficacy and side effects remain poorly understood. Although the liver is recognised as a major site of metformin pharmacodynamics, recent evidence also implicates the gut as an important site of action. Metformin has a number of actions within the gut. It increases intestinal glucose uptake and lactate production, increases GLP-1 concentrations and the bile acid pool within the intestine, and alters the microbiome. A novel delayed-release preparation of metformin has recently been shown to improve glycaemic control to a similar extent to immediate-release metformin, but with less systemic exposure. We believe that metformin response and tolerance is intrinsically linked with the gut. This review examines the passage of metformin through the gut, and how this can affect the efficacy of metformin treatment in the individual, and contribute to the side effects associated with metformin intolerance.",

keywords = "Bile acids, DPP-4, GLP-1, Gut/intestine, Lactate, Metformin, Microbiome, OCT1, Review, Serotonin, Uptake",

author = "McCreight, {Laura J.} and Bailey, {Clifford J.} and Pearson, {Ewan R.}",

note = "This work is funded by the Wellcome Trust New Investigator Award, awarded to ERP.",

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AU - Bailey, Clifford J.

AU - Pearson, Ewan R.

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PY - 2016/3

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Metformin and the gastrointestinal tract

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Stratified Medicine in Type 2 Diabetes: Insights from the Study of Drug Response (New Investigator Award)

Cite this

Metformin and the gastrointestinal tract

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Projects

Stratified Medicine in Type 2 Diabetes: Insights from the Study of Drug Response (New Investigator Award)

Cite this