Metformin and the gastrointestinal tract

McCreight, Laura J., Bailey, Clifford J. and Pearson, Ewan R. (2016). Metformin and the gastrointestinal tract. Diabetologia, 59 (3), pp. 426-435.

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.

Publication DOI: https://doi.org/10.1007/s00125-015-3844-9
Divisions: Life & Health Sciences > Biosciences
Life & Health Sciences
Additional Information: 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. Funding: Wellcome Trust New Investigator Award.
Uncontrolled Keywords: bile acids,DPP-4,GLP-1,gut,lactate,metformin,microbiome,OCT1,review,serotonin,uptake,intestine,Internal Medicine,Endocrinology, Diabetes and Metabolism
Full Text Link:
Related URLs: http://www.scop ... tnerID=8YFLogxK (Scopus URL)
http://link.spr ... 0125-015-3844-9 (Publisher URL)
Published Date: 2016-03-01
Authors: McCreight, Laura J.
Bailey, Clifford J. ( 0000-0002-6998-6811)
Pearson, Ewan R.

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