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This early worsening phenomenon related to the speed and degree of improvement in glycaemic control has been accepted by Public Health England

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Patients should stop the medication and seek immediate medical attention for severe, persistent abdominal pain, intractable vomiting, jaundice, or signs of pancreatitis or gallbladder disease

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Downstream interaction by glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide agonism is required for synergistic effects on body weight