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The Acarbose Cardiovascular Evaluation (ACE) trial, which enrolled 7,500 Chinese subjects (of which 6,522 completed the trial) with coronary heart disease and impaired glucose tolerance, found acarbose treatment for four months reduced the incidence of diabetes and promoted regression to normoglycemia (Gerstein 2020)

Interestingly, DPP-4 inhibition does not have to take place systemically but only in the intestine as shown with oral administration of low doses of inhibitor (122)

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Alcohol can unpredictably affect blood sugar levels and may exacerbate side effects like severe nausea

Notably, while persistence with semaglutide was lower compared to placebo, existing evidence indicates that semaglutide has a lower discontinuation rate relative to other GLP-1 RAs [53]