Effect of metformin on central arterial stiffness in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis

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Anditri Weningtyas, Victor Alvianoes Guterez Hose, Risa Ramadhiani, Mohammad Saifur Rohman, Dian Nugrahenny, Achmad Rudijanto

2026 Diabetes Research and Clinical Practice Vol. 231 Review Cited by 0

Abstract

Type 2 diabetes mellitus (T2DM) is a global health problem linked to hyperglycemia and cardiovascular complications, including central arterial stiffness. Metformin, the first-line therapy for T2DM, has been suggested to provide vascular protection, although evidence on arterial stiffness is inconsistent. This study investigated the effect of metformin on central arterial stiffness through systematic searches of PubMed/MEDLINE, ScienceDirect, Cochrane, and Google Scholar. Three reviewers independently performed data extraction and quality assessment, and pooled analyses were conducted in RevMan 5.4.1 (PROSPERO 1135002). Results showed no significant difference in pulse wave velocity (PWV) between metformin (8.9–11.2 m/s) and comparison groups (8.0–11.8 m/s), with a pooled mean difference (MD) of 0.09 m/s (95 % CI –0.06 to 0.25; p = 0.23; I2 = 0 %). However, metformin was associated with significantly higher central systolic blood pressure (cSBP) compared with controls (MD 3.30 mmHg, 95 % CI 0.60 to 6.00; p = 0.02; I2 = 0 %). In conclusion, metformin does not significantly affect PWV but is linked to a modest increase in cSBP, highlighting the need for larger studies to clarify its vascular implications. © 2025

Affiliations

Doctoral Program in Medical Sciences, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia; Department of Medicine, Faculty of Medicine, Universitas Negeri Malang, Malang, Indonesia; Cardiovascular Research Centre, Faculty of Medicine, University of Brawijaya, Indonesia; Department of Physiology, Faculty of Medicine, University of Brawijaya, Indonesia; Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia; Department of Pharmacology, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia