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The engineering involves three key modifications

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DPP-4 inhibitors did not lower the risk of any cardiorenal outcome when compared with placebo and were associated with higher risks of MACE, HHF, and renal outcome when compared with the other two drug classes

130 An important area of further study will be whether certain agents are more effective or better tolerated than others, which is of particular importance in a class of drugs that lead to gastrointestinal adverse effects in up to 70% of patients by some estimates