Exploring the Comparative Efficacy of Metformin and Resveratrol in the Management of Diabetes-associated Complications: A Systematic Review of Preclinical Studies

Abstract

Food-derived bioactive compounds such as resveratrol are increasingly explored for their protective effects against metabolic complications. Evidence supports the strong antioxidant properties and therapeutic effects of resveratrol in managing diabetes and its associated complications. However, evidence informing on the comparative or combination effects of this natural compound with an accomplished and well-characterized antidiabetic agent like metformin has not been revised. Thus, we conducted a comprehensive systematic search of the major electronic databases which included MEDLINE, Cochrane Library, and EMBASE. The cumulative evidence strongly supports the comparative effects of metformin and resveratrol in ameliorating diabetes-associated complications in preclinical settings. In particular, both compounds showed strong ameliorative effects against hyperglycemia, dyslipidemia, insulin resistance, a pro-inflammatory response, and lipid peroxidation in various experimental models of diabetes. Enhancing intracellular antioxidant capacity in addition to activating NAD-dependent deacetylase sirtuin-1 (SIRT1) and AMP-activated protein kinase (AMPK) are the prime mechanisms involved in the therapeutic effects of these compounds. Of interest, preclinical evidence also demonstrates that the combination treatment with these compounds may have a greater efficacy in protecting against diabetes. Thus, confirmation of such evidence in well-organized clinical trials remains crucial to uncover novel therapeutic strategies to manage diabetes and its linked complications.

Keywords: antioxidants; combination therapy; diabetes mellitus; dietary supplements; metformin; resveratrol.

Figure 1

A flow diagram showing the study selection and inclusion criteria.

Figure 2

Summary of evidence on the comparative effects of metformin and resveratrol. In addition to covering the background information for each compound, a summary of preclinical models and findings reported in review are given. In brief, through various experimental models, metformin and resveratrol displayed comparative effects in ameliorating diabetes-associated complications by improving essential metabolic parameters (including glucose and lipid metabolism), blocking pancreatic/hepatic damage, as well as ameliorating both oxidative stress and inflammation. Interestingly, the combined use of these drugs could present with much better antioxidant capacity, anti-hyperglycemic effect, and attenuation of inflammation. Abbreviations: AMPK: AMP-activated protein kinase; AKT: protein kinase B; HFD: high fat diet; HUVECs: human umbilical vascular endothelial cells; PI3K: phosphatidyl-3-kinase; SIRT1: NAD-dependent deacetylase sirtuin-1STZ: streptozotocin; T2D: type 2 diabetes.