Metformin and Vitamin B12 deficiency Reduced absorption of vitamin B12 is a side effect of long-term use of metformin
downregulation of destructive MMPs (MMP-1, MMP-3) Antioxidant systems: Increased expression of glutathione reductase, thioredoxin reductase, and superoxide dismutase isoformseffects documented in Pickarts 2015 study (PMID: 28386432) Angiogenesis control: Modulation of VEGF and angiopoietin pathways, explaining observed wound-healing acceleration in diabetic ulcer models Neuronal protection: Upregulation of neuronal survival factors and downregulation of pro-apoptotic proteins in hippocampal neuron culturesa neuroprotective dimension entirely absent from UK marketing materials This gene-regulatory breadth means clinical applications extend far beyond dermal cosmesis

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Much of the current research comes from animal and laboratory studies, so findings are still emerging