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Patients with a history of medullary thyroid carcinoma or MEN 2 syndrome should not use any GLP-1 receptor agonist

The GLP-1R is colored grey

In patients in whom the major therapeutic goal is the compelling need to minimize the therapeutic risk pf hypoglycaemia, DPP-4 inhibitors are recommended as second line therapy after metformin failure at the same level as second line treatment options with GLP-1 receptor agonists, SGLT-2 inhibitors, or TZDs