Bi-directional drug-microbiome interactions of anti-diabetics

EBioMedicine. 2019 Jan;39:591-602. doi: 10.1016/j.ebiom.2018.11.046. Epub 2018 Dec 13.


Type 2 diabetes (T2D) has become a global epidemic. Although several drugs are available to manage T2D, problems associated with person-to-person variability in drug efficacy and potential side-effects remain unresolved. Owing to the emerging role of the gut microbiome in obesity and T2D, the interaction between gut microbes and anti-diabetic drugs and its influence on drugs' functions remains of immediate research interest. On one hand, drugs can manipulate gut microbiome composition and metabolic capacity. Conversely, the metabolic activities of the microbiome and its metabolites can also influence drug metabolism and effects. Hence, understanding this bi-directional drug-microbiome interaction and how it influences the clinical outcomes of antidiabetic drugs can pave the way to develop next-generation strategies to ameliorate diabetes. This review presents evidences demonstrating the putative interactions between anti-diabetic drugs and the gut microbiome, and discusses the potential of microbiome modulators to manipulate drug-microbiome interactions and the drug metabolism.

Keywords: Diabetes; Drugs; Metformin; Microbiome; Prebiotics; Probiotics; Type-2 diabetes.

Publication types

  • Review

MeSH terms

  • Archaea / drug effects
  • Archaea / physiology
  • Bacterial Physiological Phenomena / drug effects
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / metabolism
  • Fungi / drug effects
  • Fungi / physiology
  • Gastrointestinal Microbiome / drug effects*
  • Gene Expression Regulation / drug effects
  • Humans
  • Hypoglycemic Agents / pharmacokinetics
  • Hypoglycemic Agents / pharmacology*
  • Hypoglycemic Agents / therapeutic use
  • Virus Physiological Phenomena / drug effects


  • Hypoglycemic Agents