Acting as a weak activator of AMP-activated protein kinase, metformin has established itself as a cost-effective first line agent in the management of type 2 diabetes (T2DM). Besides slowing progression to this condition, its use is associated with improved survival and lower rates of myocardial infarction in T2DM, as well as benefits in stable patients with heart failure. Metformin may play a valuable role in early nephropathy, non-alcoholic fatty liver disease and as adjunct therapy in type 1 diabetes. It is increasingly advocated in patients with gestational diabetes and polycystic ovary syndrome. Its role as an anti-cancer agent remains controversial.peer-reviewe
