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The exact moa is not known, but it decreases gluconeogenesis and increases insulin sensitivity, unlike sulfonylureas, which would cause hypoglycemia
In their 2025 study, tests on mice showed metformin traveling to the VMH(a brain part), where it helps tackle type 2 diabetes by essentially turning off Rap1.
Thats also one of the proposed moa of metformin recently
When the researchers bred mice without Rap1, metformin then had no impact on a diabetes-like condition – even though other drugs did. It's strong evidence that metformin works in the brain, through a different mechanism than other drugs.
this drug is very safe first line in newly diagnosed type 2 It doent have major side effects and its a very inexpensive drug