# Effect of Metformin on Clinical Course of Non-Diabetic Patients with Ischemic Stroke: Metformin and Outcomes in Non-diabetic Ischemic Stroke

## TL;DR

This study finds that metformin improves neurological outcomes in non-diabetic stroke patients when taken for three months.

## Contribution

The novel finding is that metformin, typically used for diabetes, shows neuroprotective benefits in non-diabetic stroke patients.

## Key findings

- Metformin significantly improved NIHSS scores at two and three months compared to placebo.
- Improvements were observed in motor, sensory, facial, and visual functions.
- Metformin was well tolerated with only mild gastrointestinal side effects.

## Abstract

Background: Metformin is commonly used in diabetic patients, but its
neuroprotective effects in non-diabetic stroke patients are less understood.
This study aimed to evaluate the effect of metformin on the clinical course
of acute ischemic stroke in non-diabetic patients.

Materials and Methods: In this double-blind randomized clinical trial, 70
non-diabetic patients with acute ischemic stroke confirmed by brain imaging
(CT or MRI) within 24 hours of symptom onset were randomly assigned to
receive either metformin (500 mg once daily) or placebo for three months,
alongside standard care. NIHSS sub-scores were categorized into clinically
relevant groups (0=no deficit, 1=mild, 2=moderate, 3=severe) to account for
heterogeneity of stroke manifestations. Clinical outcomes, including motor,
sensory, visual, and facial function, were assessed at baseline, one, two,
and three months. Adverse events were monitored throughout the study.

Results: No serious adverse events were observed; mild gastrointestinal
symptoms occurred in 2 patients (5.7%) in the metformin group. Compared with
placebo, metformin significantly improved overall NIHSS scores at two and
three months (P=0.021 and P=0.003), with notable improvements in motor,
sensory, facial, and visual functions. Best Gaze remained normal in most
patients. These findings are consistent with previous RCTs reporting
neuroprotective effects of metformin in non-diabetic stroke patients.

Conclusion: Metformin at 500 mg daily for three months is well tolerated and
significantly improves neurological outcomes in non-diabetic patients with
acute ischemic stroke, particularly in motor, sensory, facial, and visual
domains. These results support the potential use of metformin as an adjunct
therapy in stroke rehabilitation.