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Further, ~5% of patients are intolerant to metformin 18,20

Research Journal of Microbiology,2011, 6: 310-321.and roles in disease

This broad regulatory activity includes upregulation of tissue repair genes, collagen synthesis pathways, antioxidant defense systems, and anti-inflammatory signaling networks, alongside simultaneous downregulation of genes associated with tissue destruction, inflammation, and fibrosis

Mechanistic investigations revealed OBBs dual regulatory capacity: (i) AMPK hyperphosphorylation-mediated bioenergetic enhancement through UCP1 upregulation, and (ii) inflammation resolution via inhibiting aberrant phosphorylation of IRS-1 coupled with coordinated modulation of immunometabolic signalingsuppressing proinflammatory mediators (MCP-1, CD68, Nos2, CD11c) while activating the downstream protein expression and phosphorylation (PI3K, p-Akt/Akt and p-GSK-3/GSK-3) [215]