Gut microbesSep 29, 2025

Impact of Metformin and Liraglutide on Gut Health in Young People with Type 2 Diabetes

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Jun 28, 2026

Abstract

Essence

In African American youth with type 2 diabetes, metformin with or without liraglutide was linked to distinct gut microbiome and bile acid changes, and one secondary bile acid shift tracked lower fasting glucose.

Evidence

A 3-month randomized parallel clinical trial in 25 African American youth with youth-onset type 2 diabetes compared metformin alone with metformin plus liraglutide using gut microbiome and plasma metabolomic profiling.

Caveat

This was a small, short-term trial, and most microbiota shifts were not associated with short-chain fatty acids, hemoglobin A1c, or glucose.

Simplified

Metformin (Met) and liraglutide (Lira) are preferred diabetes therapies that may improve glycemia by modulating the gut microbiome, but the mechanisms and pathways are unknown and few data exist in youth-onset type 2 diabetes (Y-T2D). In a 3-month parallel clinical trial in African American Y-T2D randomized to Met ( = 14) or Met+Lira ( = 11), we compared gut microbial composition and metabolomic profiles and determined the relationship of changes in microbial abundance with glycemia and plasma metabolites. After 3 months, Met was associated with greater relative abundance ofandand lower( < 0.05). Met+Lira was associated with greaterand lower( < 0.05). Met group had increased (>1.5-fold) plasma cholic secondary bile acids (sulfochenodeoxycholic acid, nutriacholic acid, alpha-muricholic acid, and C24 dihydroxy bile acid; ≤ 0.002). The change in nutriacholic acid correlated with lower fasting glucose ( = -0.7, < 0.05). Shifts in microbiota taxa were not associated with plasma short-chain fatty acids (SCFA), hemoglobin A1c or glucose. Short-term Met and Met+Lira in Y-T2D were related to distinct shifts toward bile acid and SCFA-producing gut microbiota taxa, and secondary bile acid metabolites correlated with improved glycemia, suggesting bile acid pathways may be important modulators of glycemia in youth on metformin.: NCT02960659. n n Eubacterium Eubacterium rectale Bacteroides ovates p Bacteroides fragilis Streptococcus thermophilus p p r p Clinical trials.gov identifier

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Impact of Metformin and Liraglutide on Gut Health in Young People with Type 2 Diabetes

Abstract

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