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and it should be discontinued in patients with an estimated GFR less than 30 mL per minute per 1.73 m 2.13,14 A Cochrane review pooling data from 347 trials revealed no cases of lactic acidosis in more than 70,000 patient-years of metformin use

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Serati AR, Motamedi MR, Emami S, et al

The body composition shift that tesamorelin produces is therefore a two-sided change: visceral fat goes down, lean mass is maintained or improved, and the ratio between fat and muscle in the abdominal region moves in a favorable direction even when total body weight changes only modestly