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doi: 10.1002/14651858.CD011038.pub2 81 RowledgeAMillerCPerryEMcGuinessWFrescosN

[21] [22] Metformin alone rarely causes hypoglycemia during exercise because it improves insulin sensitivity rather than stimulating insulin secretion

Experimental investigations have demonstrated that cholangiocytes are sensitive to GLP-1 and respond with augmented proliferation, potentially increasing the risk of duct obstruction [47,48]

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Abstracts not about psychiatry, neurology, or neuroscience were excluded

But diagnosis itself is a problem, with average delays of 7 to 10 years between symptom onset and confirmation