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It's important to note that for patients with diabetes and CKD, the ADA and KDIGO now recommend SGLT2 inhibitors for kidney and cardiovascular protection independent of A1C levels, with metformin used when eGFR is adequate (≥30 mL/min/1.73 m²) and tolerated

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When a compound has such a narrow target, the potential for off-target side effects is inherently limited