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Flowchart illustrating the sequential patient selection process for the GLP-1RA and SGLT-2i study cohorts from the Shanghai Hospital Link Database (SHLD)

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The review found moderate-certainty evidence that tramadol users were more than twice as likely to experience a serious adverse event, such as cardiac problems or newly diagnosed cancers, though the researchers noted the short duration of the trials (mostly under 16 weeks) meant a causal link to cancer couldnt be confirmed