Cited by 479Metabolism, Diabetes, and CancerDiabetes Treatment and ManagementNatural Antidiabetic Agents Studies

Molecular mechanism of action of metformin: old or new insights?

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Rena, Graham, Pearson, Ewan R., Sakamoto, Kei·2013·Diabetologia

Abstract

Metformin is the first-line drug treatment for type 2 diabetes. Globally, over 100 million patients are prescribed this drug annually. Metformin was discovered before the era of target-based drug discovery and its molecular mechanism of action remains an area of vigorous diabetes research. An improvement in our understanding of metformin's molecular targets is likely to enable target-based identification of second-generation drugs with similar properties, a development that has been impossible up to now. The notion that 5' AMP-activated protein kinase (AMPK) mediates the anti-hyperglycaemic action of metformin has recently been challenged by genetic loss-of-function studies, thrusting the AMPK-independent effects of the drug into the spotlight for the first time in more than a decade. Key AMPK-independent effects of the drug include the mitochondrial actions that have been known for many years and which are still thought to be the primary site of action of metformin. Coupled with recent evidence of AMPK-independent effects on the counter-regulatory hormone glucagon, new paradigms of AMPK-independent drug action are beginning to take shape. In this review we summarise the recent research developments on the molecular action of metformin.

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  • Metformin is an insulin-sensitizing drug known to inhibit gluconeogenesis and lipogenesis.

    “Metformin is an insulin-sensitizing drug, known to inhibit gluconeogenesis and lipogenesis (7)”

    From Metformin and Combined Oral Contraceptive Pills in the Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis (2024) · cites this paper as [7]

    The figure caption in “Molecular action and target of metformin: lessons and insights from early studies” (page unavailable) describes reduced hepatic gluconeogenesis and inhibition of lipid synthesis, supporting the two inhibition claims. The passages do not establish the separate description of metformin as an insulin-sensitizing drug. (LLM, conf=0.83)

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Authors
Rena, G., Pearson, E. R., & Sakamoto, K.
Affiliations
  • University of Dundee (GB)
  • École Polytechnique Fédérale de Lausanne (CH)
Corresponding author
  • Rena, Graham
  • Sakamoto, Kei
Venue
Diabetologia
Published
2013-07-09
Volume
56
Issue
9
Pages
1898-1906
ISSN
  • 0012-186X (ISSN-L)
  • 1432-0428
OpenAlex
W2025130292
Cited by
479
References
98
Citations by year
2026: 9 · 2025: 22 · 2024: 20 · 2023: 33 · 2022: 22 · 2021: 52 · 2020: 33 · 2019: 38 · 2018: 58 · 2017: 51 · 2016: 37 · 2015: 52 · 2014: 43 · 2013: 8
FWCI
4.39
Type
journal article
Language
en
Open access
Locations
  • Diabetologia (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • reroDoc Digital Library (submittedVersion)
  • Discovery Research Portal (University of Dundee) (submittedVersion)
Funders
Medical Research Council (MR/K012924/1)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Natural Antidiabetic Agents Studies
Keywords
metformin, molecular mechanisms of action, type 2 diabetes, AMPK, glucagon, therapeutic target
MeSH terms
Diabetes Mellitus, Type 2, Energy Metabolism, Gluconeogenesis, Humans, Metformin, Models, Biological, AMP-Activated Protein Kinases

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