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In this context, metformin, a well-established initial treatment (Maruthur et al., 2016), distinguishes itself for its hypoglycemic ability and its broader effects such as enhanced endothelial function, reducing oxidative stress and insulin resistance, improving lipid profiles and managing fat redistribution (Rojas and Gomes, 2013)

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Cyanocobalamin has documented antiemetic properties, though the exact mechanism remains incompletely understood