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Tolerability issues
Tolerability is another treatment-related issue that can seriously impact
treatment adherence. T2DM treatment options offer a trade off be-
tween efficacy and tolerability due to product label restrictions and
adverse effects, e.g. weight gain, hypoglycemia, injections, heart fail-
ure and GI problems. 24, 25 Common side effects of current treatments
(metformin, SUs, glinides, TZDs, insulin, α-glucosidase inhibitors and GLP-1
mimetics/analogues) are headache, nausea, GI disorders, weight gain
and hypoglycaemia. These side effects are sometimes accompanied
by subsequent, more severe complications, e.g. hypoglycaemia may
influence cardiovascular events and dementia. 26, 27 In view of these tol-
erability issues, the guidelines make specific recommendations regard-
ing each class of T2DM treatment (Figure 2).
Figure 2. Traditional medications and their adverse effect considerations. 28
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