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Doctors noted metformin decreased glucose levels

This could include changes in alertness, most commonly experienced as somnolence (sleepiness), but this could also include insomnia

Zarda may be chewed by itself, with areca nut or in betel quid

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The prevalence was slightly higher among men compared to women, and differed by age with 26.5% of 16-24 year olds smoking which increased to 30.5% of 25-34 year olds before falling to 28.5% among those aged 35-54 years and decreasing to 9.0% among those aged 75+ years