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DPP4 have demonstrated anti hyperglycemic efficacy of DPP4 inhibitors alone or in combination, with mean change in Hb1ac-3 to -19 mmol/mol (-0.3 to -1.7%) without excess risk of hypoglycemia or weight gain (Figure 2)

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There is no official contraindication or documented drug-drug interaction between creatine supplementation and tirzepatide in the FDA-approved prescribing information or major drug interaction databases (Lexicomp, Micromedex)