INS and neuropathy: The results indicated that metformin users had markedly lower incidences of retinopathy (11.4% vs. 64.3%) and neuropathy (11.4% vs. 69.9%) compared to the insulin group, supporting its role in reducing the risk of microvascular complications, including DR [67]. While the duration of diabetes is a well-established risk factor for microvascular complications, the authors reported that it did not significantly influence any of the inflammatory markers studied, including E-selectin, which is strongly implicated in the progression of DR.