5 min
Aston University: From Metformin to modern obesity therapies
Early beginnings: from herbal medicine to modern drug The origins of a modern diabetes therapy can be traced back to Galega officinalis (goat’s rue), a herb used in European folk medicine for centuries to treat excessive thirst and urination. Its active chemical, guanidine, was found to lower blood sugar in animals in 1918, inspiring the synthesis of a family of drugs known as biguanides. Among these new drugs was metformin, created in 1922 and introduced as a treatment for diabetes in Europe in the late 1950s. However, by the 1970s, metformin was largely disregarded because other biguanide medicines were being withdrawn due to their side-effect of lactic acidosis. Revival in the 1990s: Aston’s role in rediscovery In the early 1990s, research at Aston University provided a decisive turning point. Professor Cliff Bailey and his colleagues revealed that metformin’s primary action occurred in the intestine, where it promoted glucose metabolism and reduced blood sugar without causing weight gain. Their studies clarified that concerns about lactic acid were largely due to misuse, not inherent toxicity. These findings reignited global interest in metformin. Professor Bailey presented his work as an expert witness to the US Food and Drug Administration in 1994, a critical step in securing approval of the drug in the US. He also assisted the European Medicines Agency during periodic reassessments. “My research has always focused on understanding how type 2 diabetes develops and how best to treat it.” Professor Clifford Bailey, Aston University. Establishing global first-line therapy Momentum built through the late 1990s. The UK Prospective Diabetes Study (1998) demonstrated that metformin not only improved blood sugar but also reduced cardiovascular risk, strengthening the case for its wider adoption. By 2012, the American Diabetes Association and the European Association for the Study of Diabetes recommended metformin as the preferred first-line treatment for type 2 diabetes. “We discovered that metformin worked somewhat differently from what was previously thought. By showing how it could be used safely and effectively, we helped pave the way for its wider acceptance.” Today, metformin is the most prescribed diabetes drug worldwide. It is included in the World Health Organization’s Essential Medicines List and has been taken by hundreds of millions of patients, profoundly reshaping global diabetes care. New directions: dapagliflozin and the SGLT-2 inhibitors After the success of metformin, Aston played a central role in the next wave of diabetes medicines. In the 2000s, Professor Bailey was principal investigator in clinical trials for dapagliflozin, the first of the sodium-glucose co-transporter-2 (SGLT-2) inhibitors. Unlike older therapies, SGLT inhibitors lower blood sugar by blocking reabsorption of glucose in the kidneys, causing excess glucose to be excreted in urine. Large international trials demonstrated additional benefits, including weight reduction, lower blood pressure, and improved outcomes for patients with kidney and heart disease. Since its launch in 2012, dapagliflozin has become the most widely prescribed SGLT-2 inhibitor, with more than five million patients treated. It is now embedded in global treatment guidelines, expanding therapeutic options to improve the control of blood glucose and body weight. Foundations for modern obesity therapies The influence of Aston University’s research extends beyond metformin and dapagliflozin. The University’s diabetes research team also studied gut hormones such as GIP (glucose-dependent insulinotropic peptide), which play a central role in regulating insulin secretion and fat metabolism. These early discoveries helped lay the groundwork for today’s incretin-based therapies, including combined GIP/GLP-1 receptor agonists such as tirzepatide. Now widely known as 'anti-obesity injections', these medicines emerged as diabetes treatments and are now transforming care for overweight people with and without type 2 diabetes. Key findings from the research at Aston University Metformin is now being investigated for its anti-ageing and fertility benefits Dapagliflozin shows promise against heart and kidney diseases and gout Gut hormones such as GIP may hold the key to entirely new treatment strategies Why does this matter? The work by Professor Bailey and his colleagues at Aston University has contributed to metformin’s recognition as the primary treatment worldwide for type 2 diabetes. Today, at least half of all patients in Western countries are prescribed metformin — an incredibly cost-effective medicine that continues to save lives. “We identified early on that gut hormones such as GIP were central players in the control of blood glucose and body weight — long before they became the basis for today’s new generation of anti-obesity medicines.” This original research helped lay the scientific foundation for breakthrough treatments like tirzepatide, widely hailed as a game-changer in obesity and diabetes care. Aston University also contributed to the development of dapagliflozin, the first in a new class of drugs that lower blood sugar while also protecting the heart and kidneys. “Millions of people worldwide are living longer and healthier lives because of therapies that have been underpinned by research at Aston University.” Looking ahead Type 2 diabetes remains one of the world’s most pressing health challenges, affecting more than 500 million people globally. Its progressive nature demands a continual search for safer, more effective treatments. From helping rescue a nearly forgotten drug in the 1990s to shaping the next generation of therapies, Aston University’s research has left an enduring mark on clinical practice, regulation, and patient outcomes. The legacy of this work is clear: millions of people worldwide are living longer, healthier lives because of medicines that Aston helped bring to the forefront of modern diabetes and obesity care. About Cliff Bailey is Emeritus Professor of Clinical Science and Anniversary Professor at Aston University in Birmingham, England. He has served on medical and scientific committees of Diabetes UK (formerly the British Diabetic Association), Society for Endocrinology, and European Association for the Study of Diabetes. He has served as a diabetes expert for the approval of new medicines by regulatory agencies including the European Medicines Agency and NICE. His research is mainly directed towards the pathogenesis and treatment of diabetes, especially the development of new agents to improve insulin action and reduce obesity, and the therapeutic application of surrogate beta-cells. Dr Bailey has published over 400 research papers and reviews, and four books, and he is particularly known for research on metformin. References to Case Studies and Key Sources Bailey CJ et al. Metformin: Changing the Treatment Algorithm for Type 2 Diabetes. Aston University REF Impact Case Study, 2014. Bailey CJ. Metformin: Historical Overview. Diabetologia, 2017. Bailey CJ & Day C. Treatment of Type 2 Diabetes: Future Approaches. British Medical Bulletin, 2018.
