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In other words, metformin isn't just a glucose-lowering drugit's a top-down rewiring agent for gut nutrient sensing and hormone modulation, which likely underlies the benefits observed across so many organ systems

One of the largest real-world analyses in T2DM More than 64,000 participants Evaluated a practical "everyday clinic" decision rather than an idealized RCT scenario Compared therapy intensification versus complete therapeutic switch Reflected real-world dose titration patterns and clinician behavior

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