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Metformin can also exert its glucose-lowering effects through a gut-liver-brain axis ( 3 Adverse effects 3.1 Gastrointestinal effects Despite its widespread availability and affordability, metformin is associated with gastrointestinal side effects, including nausea, vomiting, diarrhea, and bloating, affecting around 20% of patients (Sanchez-Rangel and Inzucchi, 2017
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