May 28th, 2019

How Metformin Works

Metformin has been established as an effective and affordable treatment for patients with type 2 diabetes. But how, exactly, does metformin work?

Metformin is usually the first medicine prescribed for type 2 diabetes and lowers glucose production in the liver and improves the body’s sensitivity to insulin. Metformin helps regulate blood sugar production by mimicking a particular segment of the protein CBP. The CBP protein is responsible for communication between the liver and pancreas in healthy people to regulate glucose production. But in type 2 diabetics the liver fails to sense insulin and continues to make glucose, elevating blood sugar. This condition is known as insulin resistance. Metformin works directly with the liver cells, to bypass this glitch in communication between the two and regulate the overproduction of glucose.

Research conducted at John Hopkins Children’s Center determined that the role that this particular part of the CBP protein, decreasing blood sugar, could be replicated by metformin. Fred Wondisford, MD who heads the metabolism division at the Children’s Center, which led this research, explained that metformin mimics the action of CDP, the critical protein that signals the communication between the liver and pancreas. And in this capacity, takes over as a messenger to work with the liver to signal the need to maintain glucose production.

This hypothesis was tested on mice. Test mice were given diets high in fat for the course of a few months. As a result, they developed insulin resistance. After eating their high blood glucose levels did not drop to normal levels. Having predicted that metformin worked as a distinct section of CBP, researchers then studied the effects of metformin on mice with normal CBP and mice missing this part of their CBP to prove their supposition. CBP was activated in mice treated with metformin, returning their blood glucose levels to normal.

The study further showed that metformin dosing can be individualized for each patient. A biomarker was discovered that can determine how an individual will respond to metformin treatment, giving doctors important information on prescribing the optimal dose for each patient.

The bottom line is, metformin is generally a highly successful treatment for type 2 diabetes. And can be dosed to get the optimal results for each patient, minimizing side effects and improving effectiveness. A generally well-tolerated treatment to help type 2 diabetics live healthier lives.


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