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Sulfonylureas are typically prescribed as a second-line therapy after metformin and function by stimulating insulin release from beta cells in the pancreas

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The mechanism is not entirely clear but it is hypothesized that the reduction in homocysteine from B vitamin supplementation may exert favorable and protective effects on nerve demyelination (31), and may attenuate the neurotoxic effects of homocysteine and N-methyl-D-aspartate (NMDA) agonists (32)