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Spironolactone does not reach the threshold of a "strong" dual inhibitor, so no mandatory dose adjustment exists in labeling, but the pharmacokinetic signal is real and accumulates with renal dysfunction
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For type 2 diabetes, NICE recommends GLP-1 receptor agonists when triple oral therapy is ineffective and BMI is 35 kg/m or higher (with lower thresholds for certain ethnic groups)
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