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Metformin is the first-line antidiabetic drug with over 100 million users worldwide, yet its mechanism of action remains unclear. Here the Metformin Genetics (MetGen) Consortium reports a three-stage genome-wide association study (GWAS), consisting of 13,123 participants of different ancestries. The C allele of rs8192675 in the intron of SLC2A2, which encodes the facilitated glucose transporter GLUT2, was associated with a 0.17% (P = 6.6 × 10(-14)) greater metformin-induced reduction in hemoglobin A1c (HbA1c) in 10,577 participants of European ancestry. rs8192675 was the top cis expression quantitative trait locus (cis-eQTL) for SLC2A2 in 1,226 human liver samples, suggesting a key role for hepatic GLUT2 in regulation of metformin action. Among obese individuals, C-allele homozygotes at rs8192675 had a 0.33% (3.6 mmol/mol) greater absolute HbA1c reduction than T-allele homozygotes. This was about half the effect seen with the addition of a DPP-4 inhibitor, and equated to a dose difference of 550 mg of metformin, suggesting rs8192675 as a potential biomarker for stratified medicine.

Original publication

DOI

10.1038/ng.3632

Type

Journal article

Journal

Nat Genet

Publication Date

09/2016

Volume

48

Pages

1055 - 1059

Keywords

Blood Glucose, Body Mass Index, Diabetes Mellitus, Type 2, European Continental Ancestry Group, Genome-Wide Association Study, Glucose Transporter Type 2, Hemoglobin A, Glycosylated, Humans, Hypoglycemic Agents, Metformin, Polymorphism, Single Nucleotide, Quantitative Trait, Heritable