二甲双胍作为 2 型糖尿病的基础疗法而闻名，但也用于临床医学的其他领域，具有许多新兴和潜在的适应症。它的许多有益作用可能是通过对减肥和胰岛素敏感性的适度影响来介导的，但它还有多种其他已知的作用机制。目前除 2 型糖尿病以外的临床用途包括： 多囊卵巢综合征；妊娠糖尿病/妊娠糖尿病；预防糖尿病前期的 2 型糖尿病；以及 1 型糖尿病的辅助治疗。由于二甲双胍已在临床使用近 70 年，根据定义，其在这些疾病中使用的大部分基础证据都是基于当代循证医学出现之前进行的试验。因此，上述一些用途在许多监管领域都是“标签外”的，并且它们的用途在不同国家也相应不同。展望未来，二甲双胍目前的几种“重新利用”研究用途也正在研究中：预防癌症（包括李法美尼综合征）、肾脏保护、阿尔茨海默病、代谢功能障碍相关的脂肪肝疾病和促进健康老龄化。尽管二甲双胍的寿命很长，并且目前在临床医学中除了 2 型糖尿病之外还发挥着重要作用，但它还有进一步的潜力，并且许多研究正在进行中。© 2024 作者。约翰·威利 (John Wiley) 出版的《糖尿病、肥胖和新陈代谢》

Metformin is best known as a foundational therapy for type 2 diabetes but is also used in other contexts in clinical medicine with a number of emerging and potential indications. Many of its beneficial effects may be mediated by modest effects on weight loss and insulin sensitivity, but it has multiple other known mechanisms of action. Current clinical uses beyond type 2 diabetes include: polycystic ovarian syndrome; diabetes in pregnancy/gestational diabetes; prevention of type 2 diabetes in prediabetes; and adjunct therapy in type 1 diabetes. As metformin has been in clinical use for almost 70 years, much of the underpinning evidence for its use in these conditions is, by definition, based on trials conducted before the advent of contemporary evidence-based medicine. As a result, some of the above-established uses are 'off-label' in many regulatory territories and their use varies accordingly in different countries. Going forward, several current 'repurposing' investigational uses of metformin are also being investigated: prevention of cancer (including in Li Fraumeni syndrome), renal protection, Alzheimer's disease, metabolic dysfunction-associated steatotic liver disease and promotion of healthy ageing. Despite the longevity of metformin and its important current roles beyond type 2 diabetes in clinical medicine, it has further potential and much research is ongoing.© 2024 The Author(s). Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.