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Yes, metformin is still first-line for many patients, especially those without significant cardiovascular or renal risk

Discontinuation rates: Despite higher absolute side effect rates, discontinuation due to adverse events is similar between medications (approximately 5-7% in trials)

The potential for gastrointestinal adverse effects, particularly nausea and vomiting, may lead to dehydration and worsening of renal function in vulnerable patients

Despite this, it is widely available online, as well as from gyms and beauty salons who sell it under the counter

doi:10.1038/s41419-023-05864-3 10

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