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Schiaffino S, Dyar KA, Ciciliot S, Blaauw B, Sandri M (2013) Mechanisms regulating skeletal muscle growth and atrophy

If a sufficient reduction in HbA 1c levels is not achieved with metformin, treatment is typically escalated by reinforcing the importance of diet and exercise to induce weight loss, and adding a second non-insulin pharmacological treatment (Step 2a)