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38 Conversely, in vitro data indicate that oxidative stress might be responsible for a decline in insulin action

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Several studies have also provided evidence that mitochondrial function is impaired in diabetes and thus the additional insult of metformin-induced dysfunction would be detrimental to patients with T2DM (145, 146), as was seen with the effects of metformin on old (AD10) C

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Long-term effects, especially concerning chronic conditions like acid reflux, are thus not adequately captured