New research investigating the effect of gut bacteria (microbiota) on the efficacy of type 2 diabetes drugs suggests that the composition of gut bacteria may explain why diabetes medications work for some people and not others.

Our gut microbiome can inhibit or boost the action of anti-diabetes drugs.

According to some estimates, over 415 million people worldwide currently have type 2 diabetes, which has led some scientists to refer to the condition as a “global pandemic”.  The latest report from the Centers for Disease Control and Prevention (CDC), estimate that over 100 million adults in the United States are currently living with diabetes or prediabetes.  Although there is no cure for diabetes yet, treatment and lifestyle changes can help those living with the disease.

However, diabetes drugs have varying rates of success, which depend on the form of administration and may vary from person to person.  New research, led by Hariom Yadav, Ph.D., an assistant professor of molecular medicine at the Wake Forest Baptist Medical Center in Winston-Salem, NC, investigates one of the possible causes behind such varying success rates — the gut bacteria.

Previous studies quoted by Yadav and colleagues in their paper show that the gut bacteria can “instigate” obesity and type 2 diabetes, and that people living with diabetes have an imbalance in the composition of their gut bacteria.  Also, as Yadav explains, some diabetes drugs are effective when given intravenously but do not work when taken orally.

Conversely, other drugs such as metformin, a commonly used anti-diabetes drug, works best when given orally but does not work when given through an IV.  The bacteria in the gut are key to regulating how a person metabolizes drugs.  So, based on these observations, the researchers wondered whether the composition of the gut bacteria influences the efficacy of certain diabetes medications.

To this end, Yadav and colleagues reviewed over 100 studies of rodents and humans and published their results in the journal EBioMedicine.  The research focused on how the types of gut bacteria (microbiome) either boosted or inhibited the effectiveness of the drugs. It found that modulating the gut microbiome with drugs could help boost, change, or reverse the efficacy of drugs for type 2 diabetes. 

The review of literature 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.  However, more studies are needed to continue to decipher the interactions between the gut bacteria and diabetes drugs in clinical practice, caution the authors.

This study of gut bacteria’s effect on drug metabolism is only a decade old, and the possibility of developing treatments derived from bacteria could significantly improve the efficacy of current diabetes drugs…not to mention other drugs and other diseases.