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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# Research Synthesis: Metformin Treatment Effects — full paper

## Abstract

Evidence scope: 18/33 retained sources are indirect, review-level, adjacent, or mechanistic and are used only to bound interpretation. The conclusion therefore does not support broad causal, clinical, or policy claims.

Metformin is the most widely used first-line glucose-lowering agent worldwide, yet its putative benefit…