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Methnani J, Hajbelgacem M, Ach T et al (2023) Effect of pre-meal metformin with or without an acute exercise bout on postprandial lipemic and glycemic responses in metabolic syndrome patients: a randomized, open label, crossover study

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Being me (sciencey minded) I've done my own trials on myself with in-date and out-of-date ampoules and found no difference

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This means the problem is not caused by just one factor, but by several changes happening at the same time

Those who lose the most weight tend to regain the most, but they can often maintain some weight loss compared to where they started