Diabetes-lowering drugs are ineffective? Maybe they are eaten by intestinal bacteria?

More than half of the human body's microorganisms are concentrated in the intestines. These microorganisms have diverse functions and encode more than nine million genes. Some studies have found that they can not only break down food but also break down drugs.

Acarbose, a commonly used drug for treating diabetes, is a naturally derived α-glucosidase inhibitor. It is taken orally before meals or in chewed form. It can reduce the metabolism of ingested complex carbohydrates and postprandial blood sugar levels. It is mainly used to treat type 2 diabetes.

However, more than 95% of acarbose remains unabsorbed in the intestine, and this, combined with its ability to inhibit bacterial α-glucosidase, has been shown to have a significant impact on the gut microbiome.

Recently, researchers from Princeton University in the United States discovered that there are some enzymes in the human microbiome that can specifically metabolize and inactivate acarbose.

Through metagenomic detection and analysis, they found that homologs of the enzyme that inactivates acarbose are widely present in the human oral and intestinal microbiota.

Through biochemical experiments, they proved that the two most widely distributed substances, Mak1 and AcbK, can phosphorylate acarbose and inactivate the enzyme.

Subsequently, human clinical trial data also demonstrated that the MAK gene carried in the human intestinal microbiome affects the anti-diabetic response of this drug.

For those who have taken this diabetes drug and have not seen good results, it is time to see if the intestinal flora is causing trouble!

Nature article: The human microbiome encodes resistance to the antidiabetic drug acarbose