What is the mechanism of action of oral hypoglycemic agents like metformin?

Oral hypoglycemic agents such as metformin primarily work by decreasing hepatic glucose production. This mechanism involves reducing the amount of glucose that the liver releases into the bloodstream, which is particularly important in individuals with type 2 diabetes who often experience elevated glucose levels due to excess hepatic glucose production. By acting directly on the liver to decrease this production, metformin helps to lower overall blood glucose levels, making it an effective medication in managing type 2 diabetes.

Additionally, metformin enhances insulin sensitivity in peripheral tissues, which also contributes to its blood sugar-lowering effects. However, the most distinctive and primary action of metformin is its ability to reduce hepatic glucose output, distinguishing it from other classes of hypoglycemic agents. This differentiates metformin from options related to promoting insulin secretion or inhibiting glucagon, which involve other pathways in glucose regulation.