Metformin and gut microbiota: their interactions and their impact on diabetes
Abstract
The ratio of human to bacterial cells in the human body (microbiota) is around 1:1. As a result of co-evolution of the host mucosal immune system and the microbiota, both have developed multiple mechanisms to maintain homeostasis. However, dissociations between the composition of the gut microbiota and the human host may play a crucial role in the development of type 2 diabetes. Metformin, the most frequently administered medication to treat patients with type 2 diabetes, has only recently been suggested to alter gut microbiota composition through the increase in mucin-degrading Akkermansia muciniphila, as well as several SCFA-producing (short-chain fatty acid) microbiota. The gut microbiota of participants on metformin has exerted alterations in gut metabolomics with increased ability to produce butyrate and propionate, substances involved in glucose homeostasis. Thus, metformin appears to affect the microbiome, and an individual's metformin tolerance or intolerance may be influenced by their microbiome. In this review, we will focus on the effects of metformin in gut microbiota among patients with T2DM.
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Metformin is considered one of the most prevalent medications for diabetes management.
“Metformin is considered as one of the most prevalent medications for diabetes management (179).”
From Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments (2020) · cites this paper as [179]
There are extra-hepatic sites of action of metformin with the gut being a major contributor to its clinical benefits as an anti-hyperglycemic drug via modulating glucagon-like peptide 1 levels by a duodenal AMPK-mediated pathway, as well as effects resulting from modulating the microbiota.
“We now know there are extra-hepatic sites of action of metformin with the gut being a major contributor to its clinical benefits as an anti-hyperglycemic drug via modulating glucagon-like peptide 1 (GLP-1) levels by a duodenal AMPK-mediated pathway, as well as effects resulting from modulating the microbiota (25–29).”
From A Critical Review of the Evidence That Metformin Is a Putative Anti-Aging Drug That Enhances Healthspan and Extends Lifespan (2021) · cites this paper as [29]
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- Authors
- Vallianou, N. G., Stratigou, T., & Tsagarakis, S.
- Affiliations
- Evangelismos Hospital (GR)
- Corresponding author
- Vallianou, Natalia G.
- Venue
- Hormones
- Published
- 2019-02-04
- Volume
- 18
- Issue
- 2
- Pages
- 141-144
- ISSN
- 1109-3099 (ISSN-L)
- 2520-8721
- OpenAlex
- W2913895512
- Cited by
- 138
- References
- 40
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 23 · 2023: 22 · 2022: 31 · 2021: 24 · 2020: 17
- FWCI
- 1.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- HORMONES (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- metformin, gut microbiota, type 2 diabetes, Akkermansia muciniphila, mucin degradation, short-chain fatty acids, butyrate, propionate, gut metabolomics, glucose homeostasis, metformin intolerance, host-microbiota interactions
- MeSH terms
- Gastrointestinal Microbiome, Diabetes Mellitus, Type 2, Homeostasis, Humans, Metformin, Treatment Outcome
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