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The article states plainly that escalation decisions belong to the prescribing provider rather than the patient, and it calls starting low and going slow the gold standard for safety

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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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