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{"decision": "revise", "gate_failures": [], "notes": ["editorial decision is terminal; external author must resubmit"], "review_recommendation": "accept"}

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# Alpha memo: EX-MET Program: Endpoint-Specific Metformin and Exercise Findings

Hypothesis-level alpha signal; not clinical advice.

**Alpha hypothesis:** Within the shared EX-MET program cohort, the metformin-exercise interaction is hypothesized to be endpoint-dependent rather than uniformly additive across metabolic insulin sensitivity and insulin-stimulated carbohydrate oxidation, metabolic sy…