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Ozempic has gotten a lot of buzz over the past year after researchers discovered that its active ingredient can help to treat a range of health conditions. But now, researchers have turned a fresh eye to another medication originally designed to treat type 2 diabetes: metformin.
While it was once “just” a medication for people with type 2 diabetes, metformin is now thought of as a “wonder drug with multiple potentials,” says David Cutler, M.D., a family medicine physician at Providence Saint John’s Health Center in Santa Monica, CA. In fact, recent research found it may help to lower the risk of long COVID in patients with type 2 diabetes.
Long COVID is just the most recent finding of the drug’s possible benefits. “That opens the door to more research,” says Christina Inteso, Pharm.D., a clinical pharmacy specialist at Corewell Health.
But metformin isn’t new — in fact, it’s been around for decades. “There is so much interest in metformin because it has been around for quite some time,” she says. “In addition to the long history, it is also generic, affordable and easily accessible.”
So, what can metformin be used to treat, and how does it work? Here’s everything you need to know.
What is metformin?
Metformin is a medication in a class of compounds called biguanides, according to the U.S. National Library of Medicine. These medications reduce the amount of glucose the body absorbs from food and that the liver produces. Metformin also helps the body to use insulin, a hormone that escorts glucose (blood sugar) to the cells where it’s used for energy, per the U.S. National Library of Medicine.
Diabetes management is the most common use for metformin, and what the medication is currently FDA-approved for. Metformin helps manage blood sugar in people with type 2 diabetes in a few different ways: It helps the body respond better to the insulin it makes naturally, decreases the amount of sugar the liver makes and lowers the amount of sugar the intestines absorb from food, Dr. Cutler explains.
“Metformin is very interesting, because it has multiple ways that it works in the body,” says Jamie Alan, Ph.D., an associate professor of pharmacology and toxicology at Michigan State University. “As long as you have good renal function, the side effects are somewhat limited.”
Metformin is available to treat type 2 diabetes as-is, and is also used with other drugs in some medications to treat diabetes, according to the U.S. National Library of Medicine.
Why it’s being called a “wonder drug”
There are a lot of potential uses for metformin. The keyword being potential. Because it works in the body in different ways, it’s “a good candidate for several different disease states,” Alan says.
Long COVID
Research published last year in the journal Diabetes Care analyzed health records from nearly 76,000 adults who took metformin for type 2 diabetes and compared them to more than 13,000 adults who took other types of medications for diabetes. The researchers discovered that patients who took metformin were up to 21% less likely to develop long COVID or die of complications of COVID-19 than those who didn’t take the medication.
But it appears as though it can also help people without diabetes avoid long COVID, too. Another clinical trial published in 2023 found that metformin lowered the risk of long COVID by up to 40% in adults with overweight or obesity, most of whom didn’t have diabetes.
“Metformin has some immunomodulatory actions,” Alan says — meaning, it can keep the immune system from overreacting. But the exact reason why metformin may help with long COVID is “somewhat unclear,” Alan says.
Weight management
While it doesn’t have weight loss effects on par with medications like Ozempic, Wegovy and Zepbound, metformin can help. “Metformin helps with modest weight loss that varies from person to person,” says Anupam Ohri, M.D., an associate professor in the Division of Endocrinology at Rutgers, Robert Wood Johnson Medical School.
A study published earlier this year found that metformin can reduce feelings of hunger in people on the medication. That can cause patients to lose around 2% to 3% of their body weight within the first year of taking the drug.
Healthspan and Longevity
Dr. Ohri points out that this use of metformin is “controversial” and more research is needed, but there is “growing interest” says Inteso, in the use of metformin to slow the aging process and increase life expectancy. Animal studies linked the medication to longer lifespans in mice, Inteso says. “While this is in the preliminary stage, it could be due to improving insulin resistance, antioxidant effects and the health of blood vessels,” she says.
Longevity is one potential benefit, but so is a longer “healthspan,” which is the period of time a person enjoys good health. “Effects on insulin signaling are likely involved,” Alan says. “Metformin restores insulin sensitivity, and this has been linked to weight loss and an increase in healthspan. There are likely other things at play.”
Heart disease
While this so far only applies to people with diabetes, research has found a link between metformin and a lowered risk of cardiovascular disease. Among other things, the medication may help lower the amount of fat in the blood, a person’s body weight and their blood pressure.
This may be tied to metformin’s ability to lower blood sugar, Alan says, but it’s still not entirely clear. “There could be multiple mechanisms and there is no consensus at this time,” Alan says.
Polycystic ovarian syndrome (PCOS)
Polycystic ovary syndrome is a hormonal condition that can cause a slew of health issues, including unwanted facial hair, acne, irregular periods, weight gain and infertility. “The improvement in these symptoms with metformin seems likely due to its metabolic effects at the cellular level,” Dr. Cutler says. “But it is not a cure and does not work for everyone.”
Early trials in women with PCOS found that metformin helped give a small benefit in insulin sensitivity, reduced weight and helped restore periods, Dr. Ohri says. Because of this, metformin is used “off-label” when people can’t take other medications, she says. “It can be used as an adjunct to lifestyle interventions in adults with PCOS,” Ohri adds.
Depression
A number of studies published within the last few years have pointed to metformin as a potential antidepressant, especially for people with type 2 diabetes. We don’t know the exact mechanism behind this mental health benefit, but in a research review published earlier this year, scientists stated “metformin helps reduce depressive symptoms by targeting multiple pathways, including the regulation of neurotransmitters, enhanced neurogenesis, anti-inflammatory effects, and changes in gut microbiota.”
Skin cancer
Early research suggests that people who take metformin have a lower chance of developing non-melanoma skin cancer. The study found that people taking the drug had a 67% lower chance of developing basal cell carcinoma (BCC) and a 55% lower risk of squamous cell carcinoma (SCC) compared to folks who weren’t on metformin. This is after adjusting for the use of other medications that can increase one’s risk such as hydrochlorothiazide, photosensitizing medications, tumor necrosis factor inhibitors and statins.
However, it’s worth noting that the SCC protective effect was not significant for Black individuals, possibly because SCC tends to be linked to scarring and inflammation in this group, which metformin may not have an effect on. Scientist say there are a number of other ways that metformin may reduce one’s risk of cancer, including a few mechanisms for inhibiting cancer cell growth.
Who should consider taking metformin?
If you have type 2 diabetes and aren’t already on metformin, doctors say it’s worth asking your own healthcare provider about the medication. “Metformin is a prescription medication, and one of the most commonly prescribed drugs in the world,” Dr. Cutler says.
Alan agrees. “It is cheap, with a generally favorable side effect profile,” Alan says. (Gastrointestinal issues like nausea, vomiting and diarrhea are the most common potential side effects.)
That said, “it’s important to note, if you have kidney disease or reduced kidney function, you should either not take metformin or take this drug under supervision by a healthcare professional,” Alan says.
Bottom line
Metformin has long been a trusted medication to help manage type 2 diabetes. If you have diabetes or prediabetes, ask your doctor if you’re a candidate for a prescription. While it can help people without diabetes with certain other conditions, more research is needed to see whether it should be in even wider use for others.
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