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A network meta-analysis comparing cardiovascular outcomes and mortality by GLP1-RA showed the following outcomes: MACE, cardiovascular death, death from any cause, myocardial infarction, stroke, and heart failure hospitalization 17

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To address this, the FDA updated its guidelines in 2016, allowing metformin use in patients with mild to moderate kidney impairment but advising against its use in those with severe kidney disease (eGFR below 30 mL/min/1.73 m)

Key points for future research include the following