At the same time, the incidence of diabetic nephropathy, although reduced compared to 20 years ago, is stabilized in recent years, and the incidence of end-stage renal disease (due to reduced cardiovascular mortality and increased life expectancy) is increasing [64]
The gastric emptying delay is typically dose-dependent and most pronounced during initial therapy
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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