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this is a maximum hypersensitivity reaction of the immune system with varying degrees of severity, but which can be acutely life-threatening (Bilwani et al., 2005)

Dipeptidyl peptidase-IV inhibitory activities of medicinal plants: Terminalia arjuna, commiphora mukul, gymnema sylvestre, morinda citrifolia, emblica officinalis

Theres also the issue of tolerance

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Trimi's citations of STEP 1, SURMOUNT-1, and SELECT are accurate and appropriately attributed