Gut 63:706-707 doi:10.1136/gutjnl-2013-305370
  • Commentary

The antidiabetic gutsy role of metformin uncovered?

  1. Rémy Burcelin
  1. Correspondence to Prof Rémy Burcelin, Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut de Recherche sur les Maladies Métaboliques et Cardiovasculaires de Rangueil (I2MC), Toulouse 31432, France; remy.burcelin{at}
  • Received 8 June 2013
  • Revised 16 June 2013
  • Accepted 18 June 2013
  • Published Online First 9 July 2013

Why are grams of metformin recommended to lower hyperglycaemia in type 2 diabetic patients whereas the dose ranges from micrograms to milligrams for all other antidiabetic agents? Why is that 50% of the patients should discontinue or reduce the daily therapeutic doses to avoid diarrhoea? Why has the previously established mode of action of metformin been continuously disputed and re-evaluated by the scientific community? To these questions, Shin et al 1 shifted again the paradigm related to numerous modes of action of metformin described so far to show that the drug lowers glycaemia by targeting gut microbiota. The gutsy role of metformin might have been uncovered.

For the last 50 years, ever since the biosynthesis of metformin by Emil Werner and James Bell in 1922, the scientific community has been revisiting the mode of action of the …

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