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Such studies are inherently susceptible to confounding by socioeconomic status, access to healthcare, reimbursement policies, and patient adherence, all of which may significantly impact treatment continuation and metabolic outcomes

Regular monitoring is recommended

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Dimmeler, S

485,486,489,490 This has compromised any ability to generate definitive evidence supporting the role of regular supplemental L-carnitine in the treatment of these symptoms

Dysbiosis is associated with systemic inflammation and metabolic dysfunction in diabetes, both of which can exacerbate DPN