Timing plays a key role in type 2 diabetes drug performance

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Researchers at the University of Adelaide have made promising discoveries regarding metformin, a well-known medication for type 2 diabetes that has been widely used since the 1960s.

Traditionally, patients take metformin with meals to minimize stomach upset, but new findings suggest that taking the medication before meals might be more effective.

The research team, led by Dr. Cong Xie, a postdoctoral fellow at the Adelaide Medical School’s Centre of Research Excellence in Translating Nutritional Science to Good Health, and Associate Professor Tongzhi Wu, conducted a detailed study on the gastrointestinal effects of metformin.

They worked with 16 individuals who have type 2 diabetes and were already on metformin treatment.

Published in the journal Diabetologia, their research has gained international attention and is now included in e-learning modules by the European Association for the Study of Diabetes, a major platform for diabetes research and clinical practice.

Dr. Xie explained that their experiments showed notable benefits when metformin was administered 30 to 60 minutes before a meal. This timing significantly reduced blood sugar levels and increased the release of GLP-1 (glucagon-like peptide 1) and insulin.

GLP-1 is a hormone that originates in the gut and plays several roles: it reduces appetite, stimulates insulin production, slows down the emptying of the stomach, and delays glucose absorption in the intestines.

These effects are crucial for controlling both blood sugar and body weight. Moreover, GLP-1-based medications are increasingly used to manage obesity and type 2 diabetes and are shown to lower the risk of heart disease.

Interestingly, the increase in GLP-1 levels occurred only when metformin was given before, not during, a glucose infusion, indicating that the interaction between glucose and the gut influences GLP-1 levels.

Associate Professor Wu highlighted that there was no significant difference in nausea among patients regardless of when they took metformin, which challenges the usual advice to take it with meals.

He suggested that changing the timing of metformin intake relative to meals could be a simple, cost-effective strategy to enhance its effectiveness in controlling blood sugar after meals.

The team is now looking to expand their research to see if these findings hold up in everyday settings over the long term, aiming to confirm whether taking metformin before meals consistently improves blood glucose management in people with type 2 diabetes.

This ongoing research could lead to updated guidelines for the administration of metformin, potentially helping millions manage their diabetes more effectively.

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The study was published in Diabetologia.

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