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Pulm Pharmacol Ther 69:102053

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In studies of mice, dietary sugar was found to displace a beneficial bacterium that protects against diet-induced obesity and metabolic disease [219], and high dietary sugar and fat induced gut dysbiosis, damaged the intestinal tract, and altered neurotransmitter metabolism in the brain and intestine, consequently altering brain function [220]

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Metformin has long been a top choice for the first drug to be tried if dietary and lifestyle changes are not sufficient to regain glucose control and metabolic health