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Metformin

Metformin featured article

Metformin is a drug commonly used to treat type 2 diabetes. It is the fourth most widely prescribed medication in the United States, with more than 80 million prescriptions for the drug written yearly. Metformin is in a class of drugs called biguanides, which impede liver gluconeogenesis (glucose production in the liver), thereby decreasing glucose uptake in the gut and increasing overall glucose utilization by improving insulin sensitivity in skeletal muscle and fat tissue. Multiple studies demonstrate that metformin reduces fasting blood glucose levels by as much as 3.9 mmol/L, corresponding to a nearly 2 percent decrease in HbA1c (a measure of long-term blood glucose control). Metformin is typically used in combination therapy incorporating dietary modification and other anti-diabetes drugs. Brand names of metformin sold in the United States include Glucophage, Glucophage XR, Fortamet, and Glumetza.

In recent decades, extensive research has focused on characterizing the...

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Episodes

exercise

Timing metformin to avoid negative effects on exercise adaptation: plausibility | Rhonda Patrick

Posted on August 12th 2020 (almost 5 years)

In this clip, Dr. Rhonda Patrick discusses whether timing metformin administration apart from exercise may be a strategy to overcome some of its adverse effects.

exercise

Metformin blunts exercise-induced gains in muscle, strength, and aerobic fitness | Rhonda Patrick

Posted on August 12th 2020 (almost 5 years)

In this clip, Dr. Rhonda Patrick describes the many open questions that remain regarding the interaction between metformin and exercise at the molecular level.

aging

Should healthy people take metformin? (benefits vs. negative exercise effects) | Rhonda Patrick

Posted on August 12th 2020 (almost 5 years)

In this clip, Dr. Rhonda Patrick gives her thoughts on whether healthy, active adults should take metformin.

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News & Publications

  • Nearly half of people with type 2 diabetes have multiple micronutrient deficiencies—the most common being vitamin D. nutrition.bmj.com
    Vitamin D Diabetes Micronutrients Magnesium Vitamin B12 Insulin Metformin

    Micronutrient deficiencies contribute to insulin resistance, a key driver of type 2 diabetes, but researchers still don’t fully understand their role in the disease’s progression. A recent study found that nearly half of people with type 2 diabetes suffer from multiple micronutrient deficiencies, with vitamin D being the most prevalent.

    Researchers analyzed data from studies investigating links between micronutrient deficiencies and type 2 diabetes. Their analysis included 132 studies and more than 52,000 participants.

    They found that 45% of people with type 2 diabetes had multiple micronutrient deficiencies. Women with the disease were more likely to have deficiencies, with 48% affected compared to 41% of men. Vitamin D deficiency was the most common, affecting 60% of participants, followed by magnesium (42%) and vitamin B12 (28%)—the latter being especially prevalent among people with type 2 diabetes who were taking metformin. The prevalence of deficiencies also varied by region.

    These findings suggest that micronutrient deficiencies are widespread in people with type 2 diabetes, particularly among women. Check out our many resources on micronutrients, including vitamin D and magnesium, and the long-term health consequences of deficiencies.

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  • Sulforaphane improves blood glucose control in obese people with type 2 diabetes. stm.sciencemag.org
    Nutrition Diabetes Sulforaphane NRF2 Metformin Glucoraphanin

    Type 2 diabetes is a progressive metabolic disorder characterized by high blood glucose levels and insulin resistance. Long-term complications from poorly controlled type 2 diabetes include heart disease, stroke, and kidney failure, among others. Findings from a 2017 study demonstrated that sulforaphane reduces glucose production in the liver and improves blood glucose control. Glucose is the body’s primary metabolic fuel. In the fasted state, the body can produce glucose via gluconeogenesis, a highly conserved pathway that occurs primarily in the liver. Increased liver gluconeogenesis among people with type 2 diabetes is a major contributor to high blood glucose and subsequent disease complications.

    The authors of the study investigated the effects of sulforaphane in several rodent models of type 2 diabetes and found that sulforaphane ameliorated many of the hallmark characteristics of the disease. Then they assessed sulforaphane’s effects in 97 people with type 2 diabetes. Sixty of the participants had well-regulated disease, but 37 had poorly regulated disease. Of those with poorly regulated disease, 17 had obesity. Nearly all of the participants took metformin, a common blood glucose-lowering drug.

    Participants received either an oral placebo or glucoraphanin-rich broccoli sprout extract every day for 12 weeks. The authors of the study measured the participants' fasting blood glucose and HbA1c (a measure of long-term blood glucose control) levels and assessed their glucose tolerance prior to and after the intervention.

    Sulforaphane administration improved fasting blood glucose and HbA1c levels in the obese participants who had poorly regulated type 2 diabetes. Sulforaphane mediated these effects via Nrf2 activity and subsequent reduced expression of enzymes that promote glucose production in the liver.

    These findings suggest that sulforaphane ameliorates some of the hallmark characteristics of diabetes in humans. The mechanisms by which sulforaphane mediates these effects differ from those of metformin, suggesting that the two could work in a complementary manner to improve blood glucose control in obese people with type 2 diabetes.

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  • Chloroquine or hydroxychloroquine, when used in combination with metformin, increased risk of death in mice blogs.sciencemag.org
    Metabolic Syndrome COVID-19 Metformin

    Chloroquine and hydroxychloroquine are antimalarial drugs currently being used under Emergency Use Authorization as treatments for COVID-19. Recently published data from a mouse study suggest that these drugs carry a significant risk of death when either is given in combination with metformin.

    Metformin is a drug commonly used to treat type 2 diabetes. It is the fourth most commonly prescribed medication in the United States, with more than 80 million prescriptions for the drug written yearly.

    Previous research has demonstrated that chloroquine and metformin, when used independently, exert anti-cancer effects. The current study investigated whether the two drugs, when used in combination, would have a synergistic effect against cancer.

    The authors of the study injected mice with saline, chloroquine, hydroxychloroquine, and/or metformin for four weeks. They found that the combination of chloroquine and metformin killed 40 percent of the mice. The combination of hydroxychloroquine and metformin killed 30 to 40 percent of the mice. All the treated mice exhibited high levels of lactate dehydrogenase and creatine kinase – indicators of tissue damage. Some of the mice treated with hydroxychloroquine and metformin exhibited signs of increased autophagy in their hearts, livers, and kidneys.

    These findings suggest that when chloroquine or hydroxychloroquine are given in combination with metformin, they can increase the risk of death in mice. Further clinical trials are needed to determine if these findings translate to humans.

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