Aston University: From Metformin to modern obesity therapies

Oct 15, 2025

5 min

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 However, by the 1970s, metformin was largely disregarded because other biguanide medicines were being withdrawn due to their side-effect of lactic acidosis.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

Duodenal enteroendocrine cells & GIP as treatment targets for obesity & type 2 diabetes

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.”

Case Study: METFORMIN: CHANGING THE TREATMENT ALGORITHM FOR TYPE 2 DIABETES

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.

Connect with:

Cliff Bailey

Emeritus Professor, College of Health and Life Sciences

Professor Bailey's research is mainly directed towards the pathogenesis and treatment of diabetes.

DiabetesEndocrinologyInsulin TherapyDiabetes TreatmentsSurrogate Beta-Cells

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May 15, 2026

3 min

Major trial shows increasing bone density fails to cut fracture risk in brittle bone disease

An international clinical trial involving Aston University researchers has challenged long held assumptions about how brittle bone disease is treated in adults, after finding that substantially increasing bone density did not reduce the risk of fractures. The study, published in the Journal of the American Medical Association (JAMA), examined whether a two stage treatment using the bone building drug teriparatide followed by the bone preserving drug zoledronic acid could reduce fractures in adults with osteogenesis imperfecta, often referred to as brittle bone disease, a rare genetic condition that causes bones to break easily throughout life. Researchers followed 349 adults treated at 27 specialist centres across the UK and Europe. While the treatment led to clear increases in bone density in the spine and hip, fracture rates were no lower than among patients receiving standard care, suggesting that bone quality may matter more than bone density alone in preventing fractures in people with the condition. The findings underline a key distinction between brittle bone disease and more common bone conditions such as osteoporosis, where increasing bone density is known to reduce fracture risk. In osteogenesis imperfecta, the study suggests that bones can become denser without becoming less likely to break, indicating that the underlying quality and structure of bone tissue may play a greater role in fracture risk than density alone. Dr Zaki Hassan Smith, an endocrinologist at Aston Medical School who contributed to the research, said: “This study shows that in osteogenesis imperfecta, simply increasing bone density doesn’t necessarily translate into fewer fractures. That’s important, because it tells us that the disease is more complex than what we see on a scan. The findings help shift the focus towards understanding bone quality and how bones behave in real life, which is essential if we are to develop more effective treatments that genuinely reduce harm for patients.” Osteogenesis imperfecta is a genetic condition that affects collagen, leaving bones fragile and prone to fracture throughout life. There is currently no licensed treatment specifically approved to prevent fractures in adults with the condition, and patients often experience repeated fractures, chronic pain and long term disability. The trial tested a sequential treatment strategy commonly used in osteoporosis, where a bone building drug is followed by a treatment designed to preserve gains in bone strength. Although this approach successfully increased bone density in people with osteogenesis imperfecta, it did not reduce fracture rates, suggesting that treatment strategies effective in osteoporosis may not directly translate to rare bone diseases. Researchers did observe improvements in some quality of life measures among participants receiving the treatment, including reduced pain interference and improved mobility. However, fracture prevention remained unchanged, reinforcing the need for new approaches that target the fundamental properties of bone in osteogenesis imperfecta rather than density alone. The study was led by the University of Edinburgh and funded by the Medical Research Council and the National Institute for Health and Care Research. Aston University contributed clinical and academic expertise through Aston Medical School as part of the large international collaboration, which involved specialist centres across the UK and Europe. The study was led by the University of Edinburgh, with Aston University contributing clinical and academic expertise as part of a wider international collaboration involving multiple specialist centres across the UK and Europe. The research was funded by the Medical Research Council and the National Institute for Health and Care Research. Researchers say the findings provide important guidance for future research, helping to steer efforts towards treatments that focus on bone quality, strength and resilience in everyday life. They also highlight the value of large scale clinical trials in rare diseases, where learning what does not reduce harm is an essential step towards better care. The paper, Teriparatide Plus Zoledronic Acid for Osteogenesis Imperfecta, is published in JAMA. https://doi.org/10.1001/jama.2026.6889

May 12, 2026

3 min

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Feb 4, 2026

2 min

Aston University economists say Prime Minister can reduce UK trade vulnerability with China visit

Greenland episode exposed UK’s lack of effective response to economic coercion from allies Research shows tariff retaliation would have cost the average UK household up to £324 per year Economists say China visit is “portfolio risk management” – diversification reduces vulnerability. The Prime Minister’s visit to China – the first by a British PM since 2018 – is an opportunity to reduce the UK’s vulnerability to economic coercion, according to new research from Aston University. A policy paper from Aston Business School’s Centre for Business Prosperity analyses the January 2026 Greenland tariff episode, when President Trump threatened and then withdrew tariffs on eight European countries. The researchers found that the UK had no good options: retaliation would have made Britain worse off, while absorbing the tariffs left Europe without credible deterrence. Director of the centre for business prosperity, Professor Jun Du, said: “The Greenland episode was a wake-up call. When your principal security ally threatens economic coercion, the old assumptions about who is safe and who is dangerous no longer hold. “The PM’s China visit should be framed as portfolio risk management – building diversified trading relationships that reduce the UK’s exposure to any single partner. Just as investors don’t put all their money in one stock, countries shouldn’t put all their trade into one basket. A UK with multiple strong partnerships is harder to pressure, whether the pressure comes from Washington or Beijing.” The research found that coordinated UK–EU tariff retaliation would have cost British households up to £324 per year – the worst outcome modelled. But the authors argue that Europe has untapped leverage elsewhere: the US runs a €148 billion annual services surplus with the EU, and mutual investment exceeds €5.3 trillion. Associate professor of economics and co-author, Dr Oleksandr Shepotylo, said: “Tariff retaliation fails because it hurts consumers and distorts the economy – the retaliator suffers similarly to the target. But Europe has cards it isn’t playing. Services, investment screening, and regulatory access are pressure points where Europe can respond effectively.” UK exports to China fell by 10.4% in the year to Q2 2025, with goods exports down 23.1% – the sharpest decline among major trading partners. The researchers argue that this closes off the UK’s largest alternative market at precisely the moment US reliability is in question. The paper identifies three priorities for UK policy: Recognise the permanent incentives behind US tariffs. US tariff revenue hit $264 billion in 2025. Trade negotiations alone cannot resolve revenue-driven policy. Build UK–EU coordination on non-tariff instruments. Services, investment, procurement, and regulation offer leverage that tariffs do not. Treat China engagement as portfolio risk management. Concentration in any single market creates vulnerability. Diversification is not about picking sides – it’s about resilience. Professor Du added: “The question for the Prime Minister is whether to use this breathing space to build resilience – or wait for the next Greenland.” To read the policy paper in full, click on this link: