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Furthermore, some were these drugs were associated with potential undesirable effects, such as the risk of heart failure or fractures (complications that are especially prevalent in patients with CKD), this is the case of thiazolidinediones, and the use of sulfonylureas and insulin are associated with weight gain or the risk of hypoglycemia
PubMed, Alves, Christiano R
The trials also do not establish optimal sequencing (drug before lifestyle, lifestyle before drug, or concurrent), because SURMOUNT-3's lead-in was a specific structured program not easily replicated in clinical practice
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