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A 2024 systematic review of 10 randomised controlled trials confirmed that the combination significantly improved HbA1c, fasting blood glucose, and BMI compared to metformin alone, with no increase in adverse events

Barbour The use of diabetes technology also presents challenges

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GLP-1 RA treatment has been associated with enrichment of bacterial genera such as Akkermansia and Bacteroides , which include species with bile salt hydrolase activity and actively participate in bile acid deconjugation (83, 84)