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Malnourished children have low levels of many enzymes and it is likely that cofactors for carnitine could be lacking as well
PMID: 29 American Diabetes Association Professional Practice Committee
Kaminski MR, Lambert KA, Raspovic A, et al
C.PiotrowskaK.et al
The mechanism appears to involve altered dopamine signaling in brain reward pathways
The preference for metformin as the initial agent is based on its durable efficacy in lowering A1C, absence of risk for hypoglycemia or weight gain, relatively mild side-effect profile, longterm safety track record, and affordability
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