Metformin, a widely prescribed medication for type 2 diabetes, is increasingly recognized for its potential benefits beyond blood sugar control. First approved by the U.S. Food and Drug Administration (FDA) in 1994, metformin remains a cornerstone treatment for diabetes due to its effectiveness, affordability (often under $25 for a 90-day supply), and generally mild side effects. However, mounting research suggests it may also play a role in preventing complications of diabetes, managing other conditions like polycystic ovary syndrome (PCOS), and even reducing the risk of certain cancers and dementia.
How Metformin Works
Metformin belongs to a class of drugs called biguanides. It works by reducing glucose production in the liver and improving the body’s sensitivity to insulin, allowing muscle and fat cells to absorb glucose more effectively. This mechanism makes it a primary choice for treating type 2 diabetes, often combined with diet and exercise to maintain healthy blood sugar levels. Doctors may also prescribe it in conjunction with newer medications like semaglutide (Ozempic) or tirzepatide (Mounjaro) for enhanced blood sugar management.
Protecting Against Diabetes Complications
While primarily a diabetes medication, metformin’s benefits extend to reducing the risk of severe diabetes-related complications. Studies show it can lower the risk of cardiovascular events, heart attacks, stroke, and even death in patients with type 2 diabetes. By improving cholesterol profiles and potentially slowing plaque buildup in arteries (atherosclerosis), metformin offers a degree of cardioprotection.
Emerging Off-Label Applications
The FDA has only approved metformin for diabetes, but healthcare providers prescribe it “off-label” for a growing number of conditions. These include:
- Obesity: Metformin can aid in modest weight loss (around 10–15 pounds), which can motivate further lifestyle changes.
- PCOS: By improving insulin sensitivity, metformin helps regulate hormone balance in women with PCOS, supporting menstrual cycles and fertility. Some women have even become pregnant after starting metformin.
- Antipsychotic-Induced Weight Gain: Metformin can help mitigate weight gain associated with antipsychotic medications used to treat psychiatric conditions like schizophrenia.
- Diabetes Prevention: For overweight or obese individuals at high risk of developing type 2 diabetes, metformin can delay or prevent the onset of the disease.
- Long COVID: Early studies suggest metformin may reduce the risk of developing long COVID by as much as 41% when used in outpatient treatment.
Cancer and Cognitive Health
Research indicates metformin may lower the risk of certain cancers, particularly breast and colorectal cancer, in diabetic patients. Additionally, there’s a link between metformin use and a reduced risk of dementia, suggesting it could be a complementary therapy for those at higher risk of cognitive decline.
Expert Insight
As Dr. Susan L. Besser states, “Metformin is widely available by prescription and is relatively affordable.” Dr. Marcio Griebeler adds that its popularity stems from its efficacy in reducing glucose levels and A1C compared to other diabetes medications.
Conclusion: Metformin has proven itself as a versatile drug with potential benefits beyond its initial purpose. From diabetes management to cardiovascular protection and emerging applications in obesity, PCOS, and even long COVID, metformin’s role in healthcare continues to expand as research uncovers its broader therapeutic potential.
