100 years of biguanide, multiple benefits open a new era of diabetes treatment!

*For medical professionals only

Looking back at the road of metformin based in China, there are more explorations in addition to helping diabetes treatment, which deserves more attention

Metformin is based in China for the benefit of patients

Professor Ma Jing first shared the long history of metformin: in 1922, Irish scientists at Trinity College, Cambridge University, synthesized metformin compounds

Professor Li Xiaoying went on to share the early history of metformin in China: in 1995, metformin was launched simultaneously

Professor Feng Bo further shared the nearly ten-year history of metformin in China: In 2013, Chinese studies confirmed that metformin was used in patients with T2DM, and the hypoglycemic efficacy was not affected

Metformin weight reduction is smart

Professor Li Xiaoying pointed out that when it comes to weight loss, some people will worry that metformin will not have the risk of excessive weight loss? The answer is no

Metformin's weight-lowering effects may be attributed to the fact that metformin can regulate body fat distribution, reduce visceral and liver fat, increase lean body mass (degreased body weight), and reduce total fat gain (Figure 1) [2].

Metformin does not harm the kidneys

Professor Feng Bo mentioned that another common clinical doubt about metformin is whether it affects the patient's kidney function.
Metformin is excreted by the kidneys in prototype form, and excretion is obstructed when renal function is impaired, so the dose of metformin needs to be adjusted when renal function is impaired, but metformin itself does not affect kidney function, and even has a renal protective effect
.

In addition to reducing sugar, metformin brings surprises

In addition to hypoglycemicity, metformin in recent years in various clinical studies, showing pleiotropic benefits, taking the more concerned polycystic ovary syndrome (PCOS) as an example, Professor Li Xiaoying pointed out that metformin by improving insulin resistance in PCOS patients, improving insulin sensitivity, improving menstrual cycle, improving conception rate, its pleiotropic effect is worthy of in-depth study
.

Alzheimer's disease (AD) is a chronic neurodegenerative disease with insidious onset and progressive development, with memory impairment, language function and other cognitive decline as the main symptoms, which can lead to a decrease in the patient's ability to perform daily living and psychobehavioral abnormalities, which is a type of dementia, due to amyloid (Aβ) peptide processing disorders, resulting in insoluble Aβ deposition to form age spots
.

These plaques lead to the emergence
of a range of destructive behaviors associated with neurodegenerative degeneration and cognitive and memory impairment.

AD-related deaths, which create a severe burden of disease and a significant burden on families and societies, are now an important global public health problem, and there is still a lack of targeted treatments
.

Professor Feng Bo shared a recent study [3] that suggested that in vivo and external AD models, metformin improves cognitive and memory impairment through a variety of mechanisms, including preventing Aβ plaque formation, reducing oxidative stress, slowing neuroinflammation, and restoring neuronalism and plasticity
in the hippocampus.

For example, metformin can block NF-κB nuclear translocations, thereby attenuating inflammatory gene transcription; Alters the expression and function of various types of nitric oxide synthase (NOS); Both work to slow down neuroinflammation
.

Metformin can also mediate mitochondrial biogenesis, metabolism, and structural improvement through adenylate-activated protein kinase (AMPK); Inhibits mitochondrial reactive oxygen species (ROS) production; Prevents neuronal apoptosis, improves the oxidative defense ability of neurons, improves mitochondrial dysfunction and oxidative stress, and plays a role
in protecting nerve function.

It is hoped that more randomized controlled studies will be conducted in the future to assess the beneficial effects of metformin on cognitive function and benefit more patients
as soon as possible.

Summary:
Looking back at the evidence-based road of metformin, the accumulation of evidence has made metformin a cornerstone drug for lowering diabetes, and its multi-efficacy effects on weight adjustment and neuroprotective need to be further studied
.

It is expected that in the next hundred years, metformin can get more attention, harvest more research, and clarify more indications through more exploration to benefit more patients
.

References:

[1] Ji L,et al.
PLoS One.
2013; 8(2):e57222.

[2] Ibáñez L,et al.
J Pediatr.
2010; 156(1):98-102.

[3] Sanati M,et al.
Life Sci.
2022; 291:120299.

-End-

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