Cleveland Clinic Journal of MedicineShould I Consider Metformin Therapy for Weight Loss in Patients with Obesity but without Diabetes?

Metformin’s Role in Weight Management: Beyond Diabetes Prevention

In light of emerging evidence, metformin, a well-established diabetes medication, is gaining recognition for its weight loss benefits in patients with obesity but without diabetes. This summary distills critical insights from recent studies, underscoring metformin’s potential as a weight management tool, particularly in specific patient populations.

Key Points:

• Metformin has demonstrated modest but clinically significant weight loss effects in adults with obesity without type 2 diabetes, warranting consideration as an off-label initial therapy.
• Evidence primarily stems from the Diabetes Prevention Program (DPP) and its long-term follow-up, showing sustained weight loss with metformin compared to lifestyle interventions or placebo.
• Metformin may be particularly beneficial for weight management in specific groups, including individuals with prediabetes, those taking antipsychotic drugs, and women with polycystic ovary syndrome.
• The medication’s weight-loss effects appear to be more pronounced in individuals with higher degrees of insulin resistance.
• Metformin’s mechanisms of action on weight include appetite suppression, alterations in the gut microbiome, and increased secretion of hormones that regulate food intake.
• The safety profile of metformin is well-established, with gastrointestinal side effects being the most common.
• Renal function considerations are crucial in determining metformin dosage for weight management, especially in patients without diabetes.
• Although metformin is cost-effective, its economic impact specifically for weight loss requires further investigation.

Based on a systematic review of 53 studies, researchers concluded that independent of its therapeutic efficacy as an anti-diabetic drug, the use of metformin results in a reduction of all-cause mortality associated with diseases that accelerate aging, including cancer and cardiovascular disease.

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