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This approach in exposure selection can create selection bias where those who could tolerate the drug for 30 days and potentially were not experiencing gastroparesis (the mechanism behind aspiration pneumonia) were included in the study which might be one reason the study did not find an increase in the risk of aspiration pneumonia compared with other studies
One study showed that metformin significantly decreased thyroid nodule size by 30%50% in patients with insulin resistance [103]

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