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Life sciences · Journal article
Frontiers in Endocrinology · October 23, 2026
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Background Type 2 diabetes mellitus (T2DM) affects hundreds of millions of people worldwide. Metformin remains first-line therapy for obese T2DM; yet, 30–40% of patients fail to achieve adequate glycemic control with monotherapy, the magnitude of HbA1c reduction varies two- to threefold between individuals, and the multi-organ coordination underlying this inter-animal variation in glycemic response remains unclear. Methods Obese diabetic Mongolian gerbils were administered metformin (100 mg/kg/day, oral gavage; n = 4) or vehicle (n = 3) for 5 weeks. We performed matched transcriptomic (RNA-seq) and data-independent acquisition proteomic profiling of liver, skeletal muscle, and inguinal white adipose tissue. Cross-omics analyses were anchored to glycemic parameters, and key hepatic findings were validated by quantitative real-time polymerase chain reaction (qRT-PCR). Gut microbiota were profiled via metagenomic sequencing. Results Metformin lowered 2-hour post-load glucose (2hPG) and ameliorated hepatic steatosis. In the liver, integrated transcriptomic–proteomic analysis revealed concordant downregulation of mitochondrial substrate carriers (Slc25a47, Slc25a29, Slc25a30) and lipid-handling factors (e.g. Apoa5, Apoc2), correlating with systemic glycemic burden among treated animals. In skeletal muscle, pathway-level integration supported the activation of metabolic remodeling programs, including PPAR signaling, that were tracked with the degree of glycemic improvement among treated animals. In iWAT, transcriptomic enrichment of immune and chemokine pathways, supported by proteomic trends, suggested that, among treated animals, higher residual inflammatory activity was associated with a weaker glycemic response. Gut metagenomic profiling revealed no detectable alterations in microbial diversity or community structure. Conclusion Hepatic mitochondrial-lipid remodeling and muscle metabolic activation aligned with glycemic improvement, while adipose tissue immune signatures may contribute to inter-animal variation in glycemic response, providing a multi-organ, data-supported framework for metformin’s systemic pharmacology.