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As in the previous recommendations by the ADA and EASD (73, 74), life-style intervention (with patient education and motivation, increase of physical activity, and healthy eating) is still in the beginning and center of therapy, followed by pharmacological therapy with metformin (7074)
There is no confirmed elevated risk of suicidality, but surveillance remains warranted
Decreasing the dosage often diminishes or eliminates drug-related patient body odor or gastrointestinal symptoms when present
L-carnitine supplementation also prevents ventricular enlargement and dysfunction, reduces the infarct size and cardiac biomarkers, and diminishes the total number of cardiac events including cardiac deaths and nonfatal infarction [128, 129]
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