Compare
Side by side.
| Acarbose | Metformin | |
|---|---|---|
| Evidence | GRADE C | GRADE B |
| Category | metabolic | metabolic |
| Status | Rx | Rx |
| Typical cost | $20–$60 / mo | $5–$20 / mo |
| Mechanism | Blocks enzymes in the gut that break down starches, flattening post-meal blood sugar spikes. | Lowers glucose production by the liver and improves insulin sensitivity. It mildly affects mitochondrial energy signaling (AMPK), which may mimic some effects of caloric restriction. |
| Human evidence | ITP mouse studies show significant lifespan extension, stronger in males. Human diabetes trials (STOP-NIDDM) showed reduced progression to diabetes. No human longevity trials. | Observational data suggest diabetics on metformin may have outcomes comparable to non-diabetics. The TAME trial is designed to test aging outcomes but has not reported. Some data suggest it can blunt exercise adaptations in older adults. |
| Side effects | Gas and bloating · Diarrhea · Rare liver enzyme elevation | GI upset, diarrhea · Vitamin B12 deficiency with long use · Rare lactic acidosis (kidney impairment) |
Not medical advice — talk to a licensed clinician. Content is educational, reflects published literature, and is not a recommendation to start, stop or change any treatment.