Angiogenesis, the formation of new blood vessels from pre-existing ones, is a crucial physiological process involved in growth, development, and wound healing. It is also a significant factor in the progression of various diseases, including diabetes mellitus. In diabetic patients, particularly those with type 2 diabetes mellitus (T2DM), angiogenesis is often impaired due to chronic hyperglycemia, inflammation, and endothelial dysfunction. This impairment can lead to severe complications such as cardiovascular diseases, diabetic retinopathy, and poor wound healing.

Metformin, a widely used oral antidiabetic medication, primarily known for its glucose-lowering effects, has also been reported to influence angiogenesis. The mechanisms by which metformin may affect angiogenesis include improving endothelial function, reducing oxidative stress, and modulating inflammatory responses. Despite its potential benefits, the role of metformin in promoting or inhibiting angiogenesis in diabetic patients remains a subject of ongoing research and debate.

This systematic review aims to comprehensively analyze the existing literature on the effects of metformin on angiogenesis in patients with T2DM. By examining various endothelial markers and angiogenesis outcomes, this review seeks to elucidate the potential benefits and underlying mechanisms of metformin therapy in the context of diabetes-related angiogenesis. Through a detailed and methodical evaluation of randomized controlled trials, cohort studies, and cross-sectional studies, this review will provide insights into the impact of metformin on vascular health in diabetic patients.