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INTRODUCTION AND AIM Diabetes mellitus (DM) is one of the metabolic disorders with high prevalence.[] With more than 536.6 million cases in 2079-year-olds having been diagnosed, diabetes prevalence is reported to be 10.5% in 2021 globally and it is estimated that the number will rise to 783.2 million in 2045.[] Complications of DM are rising all over the world[ , ] and are accounting for 520% of healthcare budgets in most countries and even in some developing countries.[] DM remains one of the main causes of myocardial infarction.[ , ] Recent studies have shown a direct connection between levels of some plasma lipid profiles such as HDL cholesterol (HDL-C) level and apolipoprotein B (Apo B), apolipoprotein A1 (Apo A1), and some cardiovascular complications such as thoracic aortic atherosclerosis.[] These studies emphasize the importance of total cholesterol (TC) or LDL cholesterol (LDL-C) in raising the risk of cardiovascular disease in individuals with diabetes, which support the current recommendation to reduce LDL-C to prevent the onset of atherothrombotic vascular events in them.[ , ] In patients with type 2 diabetes, the LDL-C catabolism is significantly reduced,[] resulting in an increase of the duration of the presence of LDL-C in the plasma, which itself may increase lipid deposition in the arterial wall

There are even recent studies that have found metformin to have protective and therapeutic effects against COVID-19 (Bramante et al., 2021, 2023)

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The dose-response is real, and the desire to find a sweet spot below 5 mg is understandable for someone tolerating 2.5 mg fine but suffering at 5 mg