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Here, again, exercise may play a beneficial role

This effect on gastric emptying tends to diminish somewhat over time as the body adapts

The Association between Melatonin Receptor 1B Gene Polymorphisms and Type 2 Diabetes Mellitus (T2DM) in Chinese Populations: A Meta-Analysis. Zhang, Ye, et al

But this slowed gastric emptying also leads to increased fermentation of food by gut bacteria, which leads to the formation of hydrogen sulfide gas

For patients with an A1C of 6.5% to 7.5%, metformin is the preferred initial agent, with GLP-1 receptor agonists, dipeptidyl-peptidase-4 (DPP-4) inhibitors, thiazolidinediones (TZDs), or an alpha-glucosidase inhibitor listed as viable alternatives