**3.6 Metformin**

The principal treatment for diabetes mellitus type 2 is metformin, which is still recommended in all guidelines unless it is contraindicated. It is the primary cellular insulin sensitizer, interfering with insulin resistance, the primary pathophysiologic mechanism of type 2 diabetes [23]. Inhibiting hepatic gluconeogenesis, a supplementary method to promote normal serum glycemia is another effect of it (**Figure 7**). Hypertriglyceridemia is also improved by bringing glucose levels back to normal. Metformin uses improved

*Therapeutic Approach to NAFLD-NASH DOI: http://dx.doi.org/10.5772/intechopen.107487*

**Figure 6.**

*Pathogenesis of metabolic syndrome.*

**Figure 7.** *Action of metformin in multiple sites.*

liver ultrasound imaging and the levels of aminotransferases, particularly ALT, according to a meta-analysis of 13 prospective trials, but it did not significantly enhance all patients' histologic findings. Larger studies must be conducted and for a longer period because the number of patients included in these studies was relatively small and they were followed up for a brief period of time (in most cases 6–12 months). This will allow for a better evaluation of the effectiveness of metformin on NAFLD/NASH [24].
