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Often shipped from overseas with unknown cold-chain integrity

That distinction affects safety review, labeling requirements, dosing instruction standards, and buyer due diligence obligations

This may increase the risk of preventable complications such as diabetic foot ulcers, vision loss (from diabetic retinopathy), chronic kidney disease, heart attacks, and even strokes 1

For someone with active diverticulitis or a recent flare-up, these side effects could potentially exacerbate symptoms or make it difficult to distinguish between medication side effects and disease progression

Pharmacovigilance refinement using MedDRA + Re-run disproportionality analyses with (a) Standardised MedDRA Queries where applicable, (b) stratification by reporter type (healthcare professional vs consumer), co-medication filters (exclude SGLT2), and time-to-onset modelling to separate early dehydration-linked symptoms from later endocrine/tissue changes