Do you consider metformin as a disease-modifying adjunct in the management of patients with OA, particularly in those with comorbid metabolic syndrome or type 2 diabetes?

Based on the Pan et al. JAMA 2025 trial and the broader literature, I would not yet formally classify metformin as a DMOAD but the evidence is increasingly compelling, particularly in the metabolic OA phenotype.

This RCT provides the strongest prospective human evidence to date of a symptomatic benef...