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In the context of DR, this leads to the phosphorylation of ERK1/2, increasing downstream expression of anti-apoptotic genes like BCL2 and reducing the activity of pro-apoptotic markers such as Caspase-3
Corrado, Domenico, Peter J

Some worry about burping, including something called sulfur burps, which smell bad
Cummings DE, Purnell JQ, Frayo RS, Schimidova K, Wisse BE, Weigle DS

The most serious adverse effect is metformin-associated lactic acidosis a rare but potentially fatal build-up of lactic acid in the blood