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Certainty of evidence All primary and secondary outcomes were judged to have high certainty of evidence across all GRADE approach [11] domains, including risk of bias (D1), inconsistency (D2), indirectness (D3), imprecision (D4), publication bias (D5)

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Metformin, a commonly used medication in the biguanide class, is typically the first-line treatment for lowering blood sugar in type 2 diabetes