
    patients do not want to participate
  
['non-alcoholic fatty liver disease (nafld)']
['metformin']

        Inclusion Criteria:

          -  subjects between ages 18-80

          -  diagnosed with NAFLD by alanine aminotransferase

          -  (ALT) levels >1.5x the upper limit of normal with an otherwise nondiagnostic hepatic
             serology workup, ultrasound evidence, and/or histologically confirmed NAFLD within the
             past 1 year.

          -  The upper limit of normal for ALT will be defined as 35 U/L in males and 19 U/L in
             females

        Exclusion Criteria:

          -  A prior history of diabetes

          -  Failure to meet criteria for HbA1C screening

          -  Evidence of hepatic disorders

          -  Use of insulin or oral hypoglycemic agents

          -  eGFR <30

          -  Blood transfusion within past 3 months

          -  Steroid use in the past 6 months

          -  Excessive alcohol use (more than 20g per day in women and more than 30g per day in
             men)

          -  Acute or unstable congestive heart failure

          -  Age >80 years old

          -  Lactic acidosis

          -  Inability to consent due to cognitive impairment.

          -  Pregnancy
      