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Guidance such as the ADA/EASD Management of hyperglycaemia in type 2 diabetes consensus report (Davies et al, 2022) recommends early initiation of GLP-1 RAs or SGLT2 inhibitors along with metformin in those with established or high risk of cardiovascular disease, and it is usual practice to titrate one drug up fully before adding the second class, without waiting for further glycaemic assessment

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