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By inhibiting -glucosidase, RES reduces postprandial blood glucose spikes, contributing to improved glycemic control ( in vitro cellular experiment a RES intervention can alleviate insulin resistance (IR) and enhance the activation of AMPK ( RES can exert its anti-diabetic effects through the coordination of four mechanisms: inhibiting glucosidase activity, improving IR, protecting pancreatic -cells, and inhibiting gluconeogenesis via signaling pathways such as PI3K/serinethreonine protein kinase AKT

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Other considerations based on expert guidelines include selective serotonin reuptake inhibitors (SSRI) or tricyclic antidepressants (TCA) [97]