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Curr Diab Rep 19 , 153 (2019)

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A 3-year follow-up survey of 1,200 recipients in Manhattan, New York shows that even if overall weight rebounded by 3.0 to 5.0 kg, the circumference increase in original injection sites like the outer thighs was only 0.2 to 0.5 cm

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While the results of this article do not exclude a direct action of metformin in the liver, they suggest that the first site of metformin action is the gut, via gut-hepatic crosstalk, and that it may play a role in the control of hepatic glucose production, integrating the site and mechanism of metformin action

The primary treatment is immunomodulation (IVIG, plasma exchange, or immunosuppressants)