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( Figure 5 ) Briefly, SGLT2i inhibits the SGLT receptors in the proximal tubule, which inhibits the reabsorption of glucose from primary urine, resulting in glycosuria and a decrease in HbA1c and fasting glucose levels ( Figure 5 Clinical implications Given the significant cardioprotective effect of SGLT2i and GLP-1RAs, the ADA guidelines state that all diabetic patients with confirmed or subclinical cardiovascular disease should be prescribed a GLP-1RA class or SGLT2i class with proven cardiovascular benefit, regardless of the patients HbA1c level or the presence of other glucose-lowering medications ( Strengths and limitations To the best of our knowledge, this is the first meta-analysis to assess the effects of SGLT2i and GLP-1RAs as first-line therapeutic agents in T2DM patients with low cardiovascular disease risk

Because GLP-1 medications slow gastric motility, they can worsen bacterial overgrowth, leading to more fermentation and significantly more gas production

Insurers are a major determinant of access, sometimes limiting use to specific diagnoses or patient populations