Perspective Chapter: A Critical Overview of Metformin Use from Past to Present

Metformin, derived from Galega officinalis (Goat’s rue), is a guanidine derivative. Its molecular formula is C4H11N5, formed by the bonding of two guanidine groups via a carbon-nitrogen bridge. It is commercially available with the structural formula C4H11N5 + HCI. It has an average molecular weight of 129.16 g/mol and is frequently preferred as a first-line treatment for type 2 diabetes. It is the most commonly prescribed oral antidiabetic agent to date and can be formulated in combination with GLP-1 agonists, SGLT-2 inhibitors, and DPP-4 inhibitors, in addition to being preferred as monotherapy. In addition to type 2 diabetes, it has been observed to have positive effects on diseases such as obesity, PCOS, neurodegenerative disorders, and cardiovascular system disorders, and studies are ongoing regarding its effects on cancer and aging. Common side effects observed with long-term treatment include gastrointestinal disorders, lactic acidosis, and a decrease in vitamin B12 levels. It is more economical than most antidiabetic agents and is one of the most readily available drugs worldwide. Due to its economic benefits, ease of access, clinical reliability, and being the preferred choice in various international treatment guidelines, metformin is becoming increasingly important and is being prescribed more frequently.