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Its much less common than it is with diabetes, but it has the same pathophysiology with endothelial dysfunction. Pratley said people with established CVD or heart failure are also very likely to have CKD and should be screened by cardiologists

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Adipocyte-specific deficiency of NADPH oxidase 4 delays the onset of insulin resistance and attenuates adipose tissue inflammation in obesity

The real appeal of metformin as a tirzepatide alternative lies in its cost (as low as $4-10 per month for generic), its extensive safety record spanning decades, and emerging research suggesting longevity benefits independent of blood sugar control