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the risk is lower when combined with metformin alone, DPP-4 inhibitors, GLP-1 receptor agonists, or SGLT2 inhibitors Combination use : Some trials have examined berberine as an adjunct to metformin or other antidiabetic agents, with modest additive effects reported It would be premature and potentially unsafe to position berberine as an equivalent or replacement for metformin or any other NICE-recommended therapy based on current evidence
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