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Some people do well with other options due to fewer side effects, lower cost, or better long-term tolerability

Symbols (*, , , ) indicate significance (at 0.05 level)

In the updated guidelines, the ACP also recommends against the use of DPP-4 inhibitors alongside metformin, because new evidence showed DPP-4s didnt reduce disease or death

Sometimes the issue is dosage, sometimes timing, and sometimes dietary factors that can be adjusted

Within this framework, absorption can be considered a metabolic control module: even when dietary composition appears adequate, altered gastrointestinal kinetics may reduce effective delivery of critical substrates, shifting metabolic constraint from nutrient intake to handling efficiency