Before GLP-1 drugs came onto the market, metformin was the go-to prescription for people with type 2 diabetes. It is still one of the most widely used medications, with an estimated 200 million people worldwide relying on it to help control their blood sugar (via UC Health ). While it is considered safe and effective, metformin can cause side effects such as reduced appetite, diarrhea, or muscle cramps.

For decades, scientists have worked to understand exactly how metformin works. Much of the focus has been on its ability to activate the AMPK enzyme, which plays a key role in regulating liver metabolism. Metformin also acts in the gut, where it can shift the balance of the microbiome, increase glucose absorption, and boost hormones such as GLP-1 that promote fullness and slow digest

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