side effects compounded tirzepatide vs. Zepbound – Forbes Health Tirzepatide (Zepbound, Mounjaro): Weight Loss,

(1) Metformin upregulates the small hetero-dimer partner through the AMPK signaling pathway, which interacts directly with the cAMP-response-element-binding factor (CREB) to block the recruitment of CREB to CREB-regulated transcription co-activator 2 (CRTC2), downregulating the expression of gluconeogenic genes (4)

There are several reasons behind this recommendation

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Valenzano A, Tartaglia N, Ambrosi A, et al