Metformin: The "Star" Antidiabetic Drug—

Metformin: The "Star" Antidiabetic Drug—Is It Really Side Effect-Free and Anti-Aging?

 

When it comes to metformin, many people associate it with labels like "safe blood sugar control" and "even anti-aging." Some claim it has no liver or kidney toxicity and almost no side effects, while there are also rumors that it can delay aging, making even non-diabetics want to try it. However, as a commonly used oral antidiabetic drug in clinical practice, metformin's true nature is far more complex than these "labels": it is not without side effects, its liver and kidney safety needs to be viewed scientifically, and its "anti-aging" effect is still far from being a clinical application. Today, we will objectively analyze metformin to help you clarify common misunderstandings about it.

 

First, let's talk about the safety of metformin. It is important to clarify that it is not without side effects, with the most typical reactions concentrated in the gastrointestinal tract. Many patients experience nausea, vomiting, diarrhea, abdominal distension, or loss of appetite when they first start taking the drug, and may even feel a metallic taste in the mouth. These discomforts mostly occur in the early stages of medication, and as the body gradually adapts, the symptoms will slowly ease. Starting with a small dose or taking the drug with meals can also reduce these gastrointestinal reactions to a certain extent. In addition to gastrointestinal issues, long-term use of metformin may also affect the absorption of vitamin B12. Therefore, doctors usually recommend that patients taking the drug long-term regularly monitor their vitamin B12 levels and supplement if necessary. There is also a rare but serious side effect to be alert to—lactic acidosis. However, this situation mostly occurs in patients with high-risk factors such as pre-existing renal insufficiency, severe infection, or hypoxia. The incidence rate is extremely low in people who take the drug as prescribed, so there is no need for excessive panic.

 

Let's then look at the widely concerned issue of "liver and kidney toxicity." A common misunderstanding needs to be corrected here: metformin has no direct liver or kidney toxicity, but its use is indeed closely related to the status of liver and kidney function. From the perspective of the kidneys, metformin is mainly excreted through the kidneys. If a patient already has renal insufficiency—such as elevated serum creatinine or a decreased estimated glomerular filtration rate—the drug is likely to accumulate in the body, thereby increasing the risk of lactic acidosis. Therefore, such patients need to adjust the dose according to their renal function, or even discontinue use. From the perspective of the liver, people with normal liver function can take metformin safely. However, if there is severe liver insufficiency, such as decompensated liver cirrhosis, the normal metabolism of the drug will be affected. Such patients need to be extremely cautious when taking the drug and should regularly monitor liver function to avoid risks.

 

Next, let's discuss the controversial "anti-aging effect." In recent years, many basic studies (such as animal experiments and cell experiments) and epidemiological observations have indeed found that metformin may be related to anti-aging. Mechanistically, it may exert potential anti-aging effects by activating the AMPK signaling pathway (which regulates the body's energy metabolism), reducing oxidative stress, and inhibiting inflammatory responses. For example, in animal models, metformin can delay the aging process and improve the decline in physiological functions caused by aging; epidemiological studies have also shown that type 2 diabetes patients who take metformin long-term may have a slightly lower risk of developing aging-related diseases such as cardiovascular diseases and cognitive impairment compared to those using other antidiabetic drugs. However, it must be clear that these findings are still a long way from "clinical application."

 

Currently, no country in the world has approved metformin for the indication of "anti-aging." Its clinical uses remain the treatment of type 2 diabetes and the auxiliary improvement of insulin resistance in patients with polycystic ovary syndrome. Clinical studies on anti-aging in healthy people are still ongoing, and there is insufficient evidence to prove that it can safely and effectively delay aging in healthy individuals. Moreover, the potential side effects of long-term medication (such as vitamin B12 deficiency) also need to be weighed against the potential anti-aging effects. More importantly, under no circumstances should you take metformin on your own just because you want to "delay aging," especially for non-diabetic populations. You may easily pose health risks due to improper dosage or ignoring your own contraindications (such as hidden renal problems).

 

In summary, metformin is a safe and effective antidiabetic drug with clear clinical value in blood sugar control and improving insulin resistance. However, it is not "side effect-free"—gastrointestinal reactions and vitamin B12 absorption issues need attention. Although it has no direct liver or kidney toxicity, the medication plan needs to be adjusted according to liver and kidney function. As for "anti-aging," it is still a potential direction in the research stage and far from being a basis for medication. If you are currently taking metformin or have a need for medication, you must follow your doctor's advice and regularly monitor your blood sugar, liver and kidney function, and vitamin B12 levels. If you are interested in its anti-aging effect, you may wish to pay attention to the progress of subsequent clinical studies and avoid blind attempts. Medication safety is always the top priority. Only by rationally viewing the effects of drugs can they truly play their value.