Metformin is one of the most commonly prescribed medications in the world, with 25 million prescriptions in England in the last year alone (data are from https://openprescribing.net) for a population of 56 million people. Metformin has been in clinical use for >60 years, yet despite this, or probably because of this, the mechanism(s) for how metformin lowers glucose remains unclear. Population genetic studies have transformed our understanding of the etiology of most common and rare diseases. It follows that population pharmacogenetic studies should provide insight into variation in glycemic response to metformin, which can be attributed to variation in pharmacokinetics and pharmacodynamics of the medication. This might allow us to better understand how metformin works, enabling more targeted drug treatments or the identification of who is likely to respond or not respond.
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