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Other diabetes medication classes offer alternatives if GLP-1 therapy proves unsuitable: SGLT2 inhibitors (such as dapagliflozin or empagliflozin) provide cardiovascular and renal benefits without affecting gastric emptying, though require adequate renal function and carry risks of genital infections and diabetic ketoacidosis DPP-4 inhibitors (such as sitagliptin) work on the incretin system but with less pronounced gastrointestinal effects note these should not be combined with GLP-1 receptor agonists Traditional agents including metformin, sulfonylureas, or insulin may be appropriate depending on individual circumstances Any medication change should be made in consultation with your diabetes specialist or GP, considering your overall glycaemic control, cardiovascular risk profile, and treatment goals, in line with NICE NG28 guidance

Increase of anti-oxidation by exercise in the liver of obese Zucker rats

Back down to fairly low level cardio 1-3 miles

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