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The gut can affect how your diabetes medicine works – or doesn’t

January 17, 2019

Diabetes monitor

In simple terms, you can think of medicine as a contest between disease and drugs. New research, however, spotlights an interloper in that relationship: the gut.

The trillions of microbial cells in our gut – the human microbiome– can affect digestion, immunity and mood. They may also help determine why certain drugs work for some individuals but not for others, and why drugs sometimes work when delivered intravenously but not orally (or the other way around).

A study of diabetes studies

Researchers at the Wake Forest School of Medicine say they have recently looked at the interplay between the microbiome and Type-2 diabetes drugs. They reviewed more than 100 published studies in humans and rodents for any insights on how gut bacteria changed the effectiveness of certain drugs.

“For example, certain drugs work fine when given intravenously and go directly to the circulation, but when they are taken orally and pass through the gut, they don’t work,” said Hariom Yadav, Ph.D., assistant professor of molecular medicine at the School of Medicine, a part of Wake Forest Baptist Medical Center. “Conversely, metformin, a commonly used anti-diabetes drug, works best when given orally but does not work when given through IV.”

The review examined interactions between the most commonly prescribed anti-diabetic drugs and the microbiome, according to the school. Before being absorbed into the bloodstream, many orally administered drugs are processed by intestinal microbial enzymes. As a result, the gut microbiome influences the metabolism of the drugs, thereby affecting patients’ responses, Yadav said.

Gut conditions can help or hurt drug action

“Our review showed that the metabolic capacity of a patient’s microbiome could influence the absorption and function of these drugs by making them pharmacologically active, inactive or even toxic,” he said. “We believe that differences in an individual’s microbiome help explain why drugs will show a 90 or 50 percent optimum efficacy, but never 100 percent.”

The researchers concluded that modulation of the gut microbiome by drugs may represent a target to improve, modify or reverse the effectiveness of current medications for Type-2 diabetes.

iSpecimen supports research into the microbiome by providing researchers samples of stool, saliva and sputum as well as other biospecimens, whether banked or prospectively collected. We detailed a special order for fresh stool specimens for a pharmaceutical client’s research in a popular Specimen Spotlight post.

There’s a lot to learn about the microbiome’s mysteries. An individual’s microbial cells outnumber their human cells by 10 to 1, and microbiomes contain many more genes (PDF) than their human host.

No wonder the gut can play a pivotal role when drugs meet disease.

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