Common Diabetes Drug May Be Acting on Your Intestines

Young Woman Taking Medication

If you have diabetes or know someone who does, you’ve probably heard of the drug metformin. It’s the first line of defense in helping to get high blood sugar levels under control in people with type 2 diabetes and helps to ward off some of the damaging effects of diabetes in the long term. Scientists and physicians had proposed a number of ways metformin has this effect, but the true mechanism hasn’t been nailed down. New research out this week is showing that it may be metformin’s effect on your intestines, rather than on the rest of your body, that is actually making the biggest impact on how metformin shifts your blood sugar.

What is type 2 diabetes and how is it harmful?

Diabetes is a disease that damages your body’s ability to regulate the level of sugar in your blood. Sugar is used as a basic form of energy by all of the organs of your body, but that sugar is needed in different amounts, at different places, and at different times. As a result, your liver and pancreas work together to sense how much sugar is needed and regulate the levels in the blood to make sure all organs get the amount they need.

In type 2 diabetes, the sensors for the amount of sugar in the blood stop working. That means that insulin, a hormone the body uses to lower blood sugar levels, isn’t released when levels are too high. In addition, the body’s organs become less sensitive to the insulin that is released and fail to use sugar even when it’s available.

As a result, sugar levels may sometimes fall lower or shoot higher than they should. Low blood sugars deprive your organs of energy, causing them to shut down and eventually causing serious damage and death. High blood sugars take more time to damage organs, but eventually the sugar sticks on to and damages tissues throughout the body, leading to nerve damage, blindness, healing problems, and a host of other health issues.

Why is metformin used to treat type 2 diabetes?

There are several ways metformin is thought to help people who have type 2 diabetes. Metformin appears to improve the sensing of blood sugar through several different methods, which then helps to boost insulin release from the pancreas when sugar levels are high. Research has also shown that metformin might lower a hormone called glucagon, which increases blood sugar when levels drop too low. In doing so, it prevents blood sugar from being high when it shouldn’t be. Finally, metformin seems to boost how sensitive organs are to insulin, which causes them to draw more sugar out of the blood and lower high blood sugar levels.

How is your digestive system involved?

Past research found that metformin seemed to be less effective when it was injected directly into the bloodstream than when it was taken by mouth as a pill. This led researchers to wonder if the digestive system was somehow playing an important role in the action of metformin. Other studies found that metformin builds up to much higher levels in the lining of the intestine than it does in the blood, again indicating that the gut may be centrally important to how metformin acts in your body.

What did these researchers study and what were their results?

The team wanted to know if sending the dose of metformin more into the gut and less into the bloodstream would affect how well the drug worked. They did this by making a delayed release pill that didn’t open until it reached the ileum, the far end of the small intestine. The ileum is different from earlier parts of the small intestine in that it doesn’t absorb as much metformin and less gets into the blood as a result. The researchers could then conclude that any effects on blood sugar levels probably had more to do with effects on the intestine and less to do with effects in the rest of the body.

The team found this delayed release form of metformin did just as well as the usual, more easily absorbed forms of metformin. In fact, it did a better job than one type of metformin at lowering blood glucose levels. Their results confirm that the gut is playing an important role in the way metformin helps diabetics, but they don’t yet know how exactly that happens.

How does this impact me?

Better understanding the way diabetes drugs like metformin work can help researchers to design new ways of delivering drugs to make them more effective and may even allow them to make new drugs that work better at controlling diabetes. Because this study was a clinical trial of this new form of metformin, it may only be a few years before you see this new metformin pill on the market.