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Pharmacovigilance refinement using MedDRA + Re-run disproportionality analyses with (a) Standardised MedDRA Queries where applicable, (b) stratification by reporter type (healthcare professional vs consumer), co-medication filters (exclude SGLT2), and time-to-onset modelling to separate early dehydration-linked symptoms from later endocrine/tissue changes

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Mechanism of Action Metformin decreases hepatic glucose production and improves hepatic insulin sensitivity but has only a modest impact on peripheral insulin-mediated glucose uptake (i.e., insulin resistance), which is likely due to a reduction in hyperglycemia, triglycerides, and free fatty acid levels (48,49)