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Research indicates that co-prescribing metformin with either PPIs or H 2 RAs can have further deleterious effects on vitamin B 12 status

Hepatocyte injury triggered by ER stress, mitochondrial dysfunction, or xenobiotics produces ROS, mitochondrial DNA, and apoptotic bodies that activate Kupffer cells (KCs) and HSCs (HSCs)

doi:10.2337/db13-1093 Nishikawa T, Edelstein D, Du XL, Yamagishi S, Matsumura T, Kaneda Y, Yorek MA, Beebe D, Oates PJ, Hammes HP, Giardino I, Brownlee M (2000) Normalizing mitochondrial superoxide production blocks three pathways of hyperglycaemic damage

The condition affects roughly 1 to 3% of the general adult population, with peak incidence occurring between ages 30 and 50