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The AMPK complex regulates the activity of numerous transcription factors involved in lipid metabolism, inflammation, autophagy, and gluconeogenesis.36 At the level of the liver, gluconeogenesis is reduced due to mitochondrial complex 1 inhibition, generating an increase in potential cell reduction (NADH: NAD), as well as in mitochondrial complex IV due to the inhibition dependent on glycerol-3-phosphate dehydrogenase (mGPHD ).37 In brown fatty tissue, this biguanide reduces the proinflammatory status conditioned by M1 macrophages through hypoxia-inducible factor 1 alpha (HIF-1 alpha), restoring the beta-adrenergic response.38 In the digestive tract, it induces a transitory inhibition of glucose absorption and abundance of the sodium-glucose transporter 1 (SGLT1) in the apical membrane of the jejunal enterocytes.37 Acarbose Acarbose is an alpha-glucosidase inhibitor, a group of medications that makes up part of the oral antidiabetics that act through the competitive and reversible inhibition of intestinal alpha-glucosidase.39 Alpha-glucosidase is an intestinal enzyme that favors glucose absorption through the enzymatic degradation of polysaccharides and disaccharides into said monosaccharide

Cyanocobalamin remains a practical option for routine repletion, dietary deficiency, and cost-sensitive care

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