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This may be of clinical significance especially for medications with a narrow therapeutic index, where small differences in blood concentration might lead to therapeutic failure or adverse reactions

Before initiating JANUVIA, ask patients about a history of heart failure or other risk factors for heart failure including moderate to severe renal impairment

Very low-calorie diets should only be followed under medical supervision

Moreover, diabetic patients with poor blood sugar control or cardiovascular disease face an elevated risk of cognitive impairment occurrence and progression ( The intricate relationship between hyperglycemia, hyperinsulinemia, and the brain reveals substantial connections to cognitive decline (Rawlings et al., 2014)

doi: 10.2337/db12-1025

doi: 10.1155/2019/4578462 48