Therapeutic potential of metformin in normal glucose tolerant persons with metabolic syndrome

Abstract With an increasing prevalence of metabolic syndrome (MS) early detection and timely management of cardiometabolic risk factors are crucial to prevent complications such as type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). There are no defined treatments for MS apart from addressing each of its components such as insulin resistance, hyperinsulinaemia, obesity, dyslipidaemia, hypertension and hyperglycaemia. The mechanism responsible for diabetes prevention is related to improved insulin sensitivity and reduced hyperinsulinaemia. Metformin has been established as a first-line therapy in patients with T2DM because it counteracts hyperinsulinaemia and hyperglycaemia and reduces cardiometabolic risk. Although the cardiovascular benefits with metformin are clearly demonstrated in diabetic and prediabetic patients, the efficacy of metformin in reducing cardiometabolic risk factors in persons with MS and normal glucose tolerance (NGT) remains inconclusive. This review focuses on the evidence base considering the therapeutic potential of metformin in NGT persons with MS representing a high-risk population for development of T2DM and CVD