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This has been proposed as an indirect mechanism of action for some of the effects of metformin, and although the precise biological pathways involved remain unclear, a range of actions have been postulated, including changes to bacterial-derived pro-inflammatory compounds, changes to production of circulating bacterial metabolites with actions on AMPK and indirect effects to stimulate release of GLP-1 by the gut [100]
Both approaches produce the same end result
Lipohypertrophic tissue has altered blood supply and different structural properties than healthy subcutaneous fat
For reasons that still aren't understood, the same drug works far better for some people than for others
They present it as a medical therapy that requires screening, counseling, and follow-up
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