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As a biguanide antihyperglycemic agent, metformin works primarily by decreasing hepatic glucose production, reducing intestinal absorption of glucose, and improving insulin sensitivity in peripheral tissues

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Rather than raising NAD+ systemically (as NMN or NR supplementation does), NNMT inhibition preserves NAD+ specifically in the tissue where metabolic dysfunction is most pronounced a precision approach that appeals to researchers studying tissue-specific metabolic regulation

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While higher doses (particularly 54 mg) showed some increase in gastrointestinal-related events, these remained mild to moderate in severity and did not result in treatment discontinuation