INS and type 2 diabetes mellitus: Metformin is largely accepted as first-line glucose-lowering treatment for T2D, although its position is challenged by novel antidiabetic drugs.30 Metformin reduces hepatic glucose production by suppressing gluconeogenesis, increases fatty acid oxidation, inhibits lipolysis and fatty acid release from adipose tissue, improves peripheral insulin sensitivity, and reduces intestinal glucose absorption31; however, it has no effects on NASH progression.32