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It usually goes something like this: Start with diet, exercise, and metformin Increase the metformin dose and/or add another medication like an SGLT2 inhibitor (Jardiance, Farxiga, Invokana), DPP-4 inhibitor (Januvia, Tradjenta), or sulfonylurea (Glucotrol, Glipizide) Try a third medication Add a GLP-1 or start insulin This step-by-step process can take years, leaving blood sugar levels elevated and allowing complications to quietly develop

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