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Once reconstituted from lyophilised powder, the peptide is susceptible to hydrolysis, oxidation, aggregation, and microbial contamination, which begin immediately

The evidence for efficacy in children is weak and short-term

However, "better" depends on individual factors including side effect tolerance, availability, cost, and the value of established long-term safety data

Risk ratios (RR) for cardiovascular death estimates according to direct (DPP-4 inhibitors, GLP-1RA and SGLT-2 inhibitors against placebo) and indirect (DPP-4 inhibitors vs GLP-1RA or SGLT-2 inhibitors, and GLP-1RA vs SGLT-2 inhibitors) comparisons