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One major factor is the accumulation of lipids (fats) in the cells, particularly in muscle and liver cells

An analysis of a T2DM cohort based on metagenomic sequencing and validated in an independent cohort found that metformin-treated patients had an increase in Escherichia coli and a decrease in Intestinibacter , and that the abundance of several intestinal microbial genera was more similar to that of normal control levels, particularly Akkermansia (Forslund et al., 2015)

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