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Effect of study bias, publication bias, and small-study effects In all analyses, the pooled estimated SMDs for the subgroups of studies deemed to have low bias was within the 95% CI of the overall (Table 4), suggesting the impact of studies with higher bias was small

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Moreover, current literature suggests that gut microbiome is a strong contender in metformin therapy and the microbiome-regulated mechanisms involving alterations in the gut microbiota composition influence its pleiotropic effects (Hung et al., 2021

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