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Introduction Diabetes is one of the most common metabolic and civilizational diseases

Discontinuation or switching to alternative medications should be considered in cases of prolonged fasting, strict low-carbohydrate diets, excessive alcohol consumption, acute infections, or perioperative periods as they may increase risk [822,823]

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Clinicians should consider checking serum bicarbonate at baseline and periodically during treatment, particularly in patients with renal impairment, those following a ketogenic diet, or those taking other carbonic anhydrase inhibitors