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Over time, the buildup of fat in the liver can lead to inflammation, fibrosis (liver scarring), cirrhosis, liver cancer and the need for a liver transplant

5.4 Acts by modulating gene expression in the intestinal microbiota In addition to regulating the gene expression of BSH of probiotic bacteria (described previously, see Chapter 4.3), metformin also modulates the protein-coding genes of another microbiota

And anecdata doesnt support a revolution

Additionally, hormonal changes occur: levels of leptin (which signals fullness) drop, while ghrelin (which triggers hunger) can increase