Metformin: new perspectives for an old antidiabetic drug

Abstract

There have been numerous recent developments in new and emerging treatments for type 2 diabetes (T2DM). In parallel, unanticipated new aspects of an old drug – metformin – have been described. Metformin is a well-established first-line T2DM drug, and increasing number of studies support a role for metformin in preventing T2DM in patients with impaired glucose tolerance and/or impaired fasting glucose. Nonglycemic benefits have also been ascribed to metformin, such as vascular protection, improved lipid profiles, and reduced levels of antifibrinolytic factors. An amelioration in inflammation or endothelial dysfunction has also been shown. In addition, metformin has been used in the treatment of metabolic syndrome, nonalcoholic fatty liver disease, and polycystic ovarian syndrome in insulin-resistant women. There is also a growing body of evidence, mostly in the form of retrospective clinical data and experimental studies, that suggests that metformin may be associated with a decreased risk of developing certain forms of cancer and with a reduction in cancer volume. This articles summarizes the molecular mechanisms of the action of metformin as well as potential new indications for this well-known drug.