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A critical clinical consideration, highlighted in the 2026 ADA guidelines and other recent reviews, is that while many newer agents (GLP-1 RAs, SGLT2 inhibitors, DPP-4 inhibitors) have a low intrinsic risk of hypoglycemia as monotherapy, this risk increases substantially when they are combined with insulin or sulfonylureas
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Furthermore, it is a relatively recent hypothesis that 7nAChRs may indirectly influence neuronal behavior by regulating oxidative stress, inflammation, and apoptosis, which is becoming increasingly prevalent