Derivation Web

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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: metformin exercise protocol mismatch
**One-sentence alpha:** Metformin co-administered with exercise may shift the same anchor across glycaemic endpoints and populations, with one small trial in adults with prediabetes suggesting an additive signal on fasting insulin secretion while a larger type 2 diabetes trial suggests metformin may attenuate aerobic exercise's effect on HbA1c.
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