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These include situations where metformin is ineffective, contraindicated, or when patients fail to reach their target glycemic control despite treatment with metformin and other medications

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Early synaptic dysfunction or synaptopathy at the level of inhibitory interneurons within the entorhinal cortex and CA3 hippocampal subregion leads to hyperactivity of pyramidal cells, which appears to play a role in the progression of AD neuropathology (e.g., tauopathy) (271, 272)

It also seems to act as an antioxidant, limiting the oxidative stress that typically slows tissue recovery