Metformin (1,1-dimethylbiguanide hydrochloride) is at the moment essentially the most prescribed oral medicine for kind 2 diabetes and is taken by hundreds of thousands of individuals on daily basis. It’s cheap, efficient, and broadly accessible. The worth of a 500 mg pill is simply Rs.1. In a rustic the place diabetes remedy is a serious family expense, metformin stays one of many few medication that’s each reasonably priced and scientifically dependable. Metformin, which has been listed as a necessary medication by the World Well being Group since 2011, is mostly secure however may cause delicate gastrointestinal upset, impart a metallic style, and infrequently trigger lactic acidosis in sufferers with renal impairment. However its story spans greater than a century of neglect, rediscovery, and legitimation.
first clue
Metformin’s roots may be traced again to an herb referred to as . Gallega officinalisgenerally often known as French lilac or goat’s roux. In European people medication, it was used to deal with folks with candy urine, an outdated description of diabetes. Within the nineteenth century, chemists who analyzed this plant found that it contained guanidine, a nitrogen-rich compound that would decrease blood sugar ranges in animals. In 1918, a Japanese scientist named CK Watanabe confirmed the hypoglycemic properties of guanidine, however its toxicity made it unsuitable for people. So researchers got down to develop safer relations referred to as biguanides. In 1922, two chemists, Emil Werner and James Bell, synthesized “dimethylbiguanide,” one of many molecules that later grew to become often known as metformin. Sarcastically, insulin was found in Canada in the identical 12 months. The world’s consideration rapidly turned to insulin. Insulin can reverse lethal diabetes in kids and younger folks nearly in a single day. As compared, mildly performing compounds have attracted little consideration. Metformin quietly disappeared from scientific dialogue and went into hibernation.
construction
Metformin acts as a silent regulator, not like insulin, which delivers glucose straight into cells. It reduces glucose manufacturing within the liver, will increase the physique’s sensitivity to insulin, and improves muscle glucose uptake. It additionally alters the intestine microbiome, affecting an enzyme referred to as AMP-activated protein kinase (AMPK), also known as the cell’s “metabolic swap.” The outcomes are superb, reducing blood sugar ranges with out inflicting weight acquire or extreme hypoglycemia.
unintentional rediscovery
The story resumes throughout World Struggle II, when scientists have been looking for new anti-malarial medication. Some guanidine derivatives have been discovered to decrease blood sugar ranges in laboratory animals. In 1949, Filipino physician Eusebio Garcia examined one such compound, metformin, whereas treating sufferers with influenza. He observed that it generally lowered blood sugar ranges and briefly marketed it as an anti-flu drug named Flumamine. This statement acquired little consideration, however later attracted the eye of European researchers.
Within the Fifties, Jan Stern, an internist on the Aron Institute close to Paris, got here throughout Garcia’s outdated report and puzzled if metformin may very well be used to deal with diabetes. He labored with colleague Dennis Duvall to start testing metformin in animals after which in sufferers with adult-onset diabetes. The outcomes have been promising. Metformin reasonably lowered blood sugar, didn’t trigger harmful hypoglycemia, and was typically nicely tolerated. In 1957, Stern introduced his discovery and proposed the title glucophage, which means “sugar eater.” His analysis formally created metformin as a diabetes remedy. It was launched in France and the UK, primarily for folks with delicate overweight-related diabetes. The next 12 months, different biguanide medication similar to phenformin and buformin entered the market, providing stronger results and better dangers.
Throughout the Nineteen Sixties and Nineteen Seventies, phenformin grew to become broadly used, particularly in the USA. Nevertheless, its use was discontinued within the late Nineteen Seventies after stories of a uncommon however critical facet impact, deadly lactic acidosis. Biguanides as an entire got here below suspicion. Metformin, though safer, was condemned by the affiliation. Its use declined sharply, and a few consultants predicted it will disappear utterly. Nevertheless, researchers continued small-scale research at a number of facilities in Europe and located that metformin behaves otherwise than phenformin. The liver doesn’t metabolize it, it’s excreted unchanged by the kidneys, and it didn’t trigger vital lactic acid accumulation when prescribed to acceptable sufferers. It helped management blood sugar ranges with out inflicting weight acquire or hypoglycemia. These observations stored the drug alive.
reluctantly accredited
By the Nineteen Eighties, researchers acknowledged that many individuals with kind 2 diabetes weren’t insulin poor, however reasonably insulin resistant, which means that their our bodies produced insulin however have been unable to make use of it successfully. Metformin’s means to fight this resistance has made it essential once more. When France’s Refa sought permission to promote its drug in the USA, the Meals and Drug Administration required in depth proof. After almost a decade of evaluate, the drug was lastly accredited in Europe in 1995, nearly 40 years after its launch. Shortly thereafter, the British Potential Diabetes Examine supplied long-term knowledge exhibiting that metformin controls blood sugar ranges, reduces coronary heart assaults, and improves survival in chubby sufferers. These outcomes have made it the middle of diabetes remedy all over the world.
Fundamentals of Indian Care
In India, metformin stays the first-line drug advisable by all main pointers for kind 2 diabetes. It’s accessible by way of the federal government healthcare system and as a generic drug in non-public pharmacies. It’s simple to retailer, may be taken orally, and doesn’t require refrigeration or syringes, making it nicely suited to India’s public well being system. Metformin reduces glucose manufacturing by the liver and will increase the physique’s sensitivity to insulin. It reasonably reduces urge for food, causes delicate weight reduction, and has helpful results on ldl cholesterol and vascular operate. Most individuals tolerate it with out issues, however some might expertise abdomen discomfort initially. Its primary benefit is that it doesn’t trigger hypoglycemia when used alone.
Through the years, researchers have found new makes use of for metformin past blood sugar management. It’s broadly utilized in girls with polycystic ovary syndrome and in chosen circumstances of gestational diabetes throughout being pregnant to enhance insulin sensitivity and restore common cycles. Some research counsel that metformin might delay the onset of kind 2 diabetes in high-risk people. In current a long time, researchers have noticed that individuals who take metformin for diabetes seem to have decrease charges of sure cancers, significantly colon most cancers and breast most cancers. Laboratory exams have proven that this drug impacts mobile power pathways that have an effect on most cancers development. One other space of concern is growing older. Scientists finding out longevity have discovered that animals given metformin reside longer and develop fewer age-related ailments.
(Dr. C. Aravinda is a tutorial and public well being doctor. Views expressed are private. aravindaaiimsjr10@hotmail.com)
issued – November 13, 2025 11:11 AM IST
