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People with high blood pressure or diabetes also have an elevated risk for NAION

Tetrahydrobiopterin enhances forearm vascular response to acetylcholine in both normotensive and hypertensive individuals

Both perspectives have merit

For patients who are not well-controlled on a treatment with metformin and basal insulin, a treatment intensification with a DPP-4 inhibitor may be feasible

Important safety considerations: Seek urgent same-day medical assessment via NHS 111 or A&E for severe abdominal pain (potential pancreatitis) and stop taking the medication pending review Report persistent nausea, vomiting, or signs of dehydration Be aware of increased hypoglycaemia risk if taking insulin or sulfonylureas (dose adjustments may be needed) Attend regular monitoring appointments for kidney function, diabetic retinopathy, and other parameters Discuss contraception if you are of childbearing potential, as GLP-1 receptor agonists are generally not recommended during pregnancy or breastfeeding [11] Report any suspected side effects via the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk) Specific administration requirements vary by product

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