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For heart failure or chronic kidney disease, the American Diabetes Association generally recommends SGLT2 inhibitors as first-line agents, with GLP-1 receptor agonists considered for their benefits on atherosclerotic cardiovascular disease, glycemic control, and weight management, or when SGLT2 inhibitors are not appropriate

[ 9 , 10 ] However, despite decades of investigation, much of the available evidence comes from laboratory studies, animal models, or relatively small human trials

However, significantly higher concentrations have been reported in streams influenced by effluents from hospitals and wastewater treatment plants

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