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Metformin - a cheap, effective med for prediabetes, Covid, longevity, and aging? [1]
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Date: 2025-02-24
A patient recently asked me if I would start him on a diabetes medication called metformin. I reviewed his chart. He did not have diabetes. I asked him why he wanted metformin. He replied that he had been reading a lot about metformin on his own. Diabetes prevention, antiviral effects, anti-aging effects, maybe longevity benefits. He’s also been keeping up with my Covidlandia series in which I’ve highlighted studies showing that metformin helps prevent long Covid. Like most of us he expects to get Covid again in the future. More importantly, he does actually have prediabetes. Metformin can be used to help prevent the full blown onset of type 2 diabetes.
We talked about how metformin is generally safe, cheap, and well-tolerated except for some common GI side effects. It commonly causes diarrhea, nausea, bloating, and loss of appetite, though these symptoms typically improve over days to weeks and can be minimized by taking the medication with food. More in depth information and clinical pearls can be found here.
I said sure. The prediabetes was sufficient. But what about the rest of the claims?
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From a medieval flower to a diabetes treatment to a potential anti-aging remedy, metformin's journey is one of medicine's most fascinating stories. This humble drug, derived from the French lilac plant, continues to surprise researchers with its remarkable range of potential benefits.
Most people know metformin as the first-line treatment for type 2 diabetes. It works by reducing the liver's glucose production and improving insulin sensitivity. What's particularly appealing about metformin is its safety profile - it's generally well-tolerated, inexpensive, and has decades of clinical use backing its effectiveness. While some patients experience initial digestive side effects like nausea or diarrhea, these typically improve over time.
But here's where things get curious: researchers have discovered that metformin may be capable of much more than just controlling blood sugar. Studies suggest it could help prevent long Covid, reduce cancer risk (particularly in diabetic patients), improve fertility in women with PCOS, and maybe even slow the aging process.
The drug appears to work through multiple mechanisms, including modifying the gut microbiome and activating important cellular pathways involved in energy regulation.
Recent research has shown particularly promising results in several areas:
Long Covid prevention has emerged as one fascinating application. Studies across multiple countries have shown significantly lower risks of severe Covid outcomes in patients taking metformin, including reduced mortality and hospitalization rates.
In the realm of influenza, metformin users have shown improved survival rates and decreased hospitalization risks. There's even evidence suggesting it might enhance vaccine effectiveness in older adults.
Perhaps most intriguingly, metformin is being studied for its potential anti-aging properties. While the research is still ongoing, some studies suggest it might help improve energy metabolism and reduce inflammation - key factors in the aging process.
For those with prediabetes, metformin offers another valuable tool. The American Diabetes Association suggests considering metformin for high-risk prediabetic patients, particularly younger individuals, those with obesity, or women with a history of gestational diabetes. In the U.S. a staggering 38% of adults over 18 years of age have prediabetes; among those aged 65 years or older 49% have prediabetes. Only 1 in 8 even know they have this prediabetic status.
A recent development that's caught the medical community's attention is metformin's potential role in asthma management. A UK study found it reduced asthma exacerbations by 30% in patients with both asthma and type 2 diabetes or prediabetes - an unexpected but welcome discovery.
What makes metformin particularly appealing is its well-established safety profile and low cost. Unlike many newer medications, we have decades of clinical experience with metformin, giving us a clear understanding of its risks and benefits.
While many of these "off-label" applications still need more research to confirm their effectiveness, metformin's potential to help with such a wide range of conditions makes it one of the most intriguing medications in modern medicine. As research continues, we may discover even more applications for this versatile drug, proving that sometimes the most remarkable medical breakthroughs can come from the most humble beginnings.
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