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That third target, the glucagon receptor, adds direct metabolic activation that increases energy expenditure and fat oxidation beyond what dual agonists achieve

Some are choosing to provide enhanced coverage, though they're not especially satisfied with pricing of these drugs

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It is contraindicated in active malignancy and during pregnancy

Diabetes Care (2014) 37(10):288494.10.2337/dc14-0865 Summary Keywords CD26/DPP4, soluble DPP4, type 2 diabetes mellitus, incretins, DPP4 inhibitors/gliptins, multifunctional enzyme Citation Rhrborn D, Wronkowitz N and Eckel J (2015) DPP4 in Diabetes