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Even when diagnosed, disease management is frequently suboptimal owing to persistent hyperglycemia, poor adherence to treatment, and low patient awareness [24,25,26]

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Additionally, unregulated artisanal kefir production poses safety risks due to microbial variability and potential contamination, including the proliferation of pathogens like Staphylococcus aureus (Angelidis et al., 2020)

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