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In women going through perimenopause or menopause, where metabolism often shifts, this can be particularly protective

[24] Finally, a 2020 Cochrane systematic review found insufficient evidence to suggest that metformin monotherapy reduced all-cause mortality, serious adverse events, cardiovascular mortality, non-fatal myocardial infarction, non-fatal stroke, or end-stage renal disease when compared to DPP-4 inhibitors for the treatment of type 2 diabetes

Each additional receptor target introduces new metabolic pathways into the compound's mechanism of action

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Ammonia readily crosses the blood-brain barrier and is thought to inhibit glutamate uptake, thereby increasing extracellular glutamate concentrations in the brain and resulting in activation of NMDA receptors