MetforminMetformin (oral) High No Neutral (potential for modest loss) Potential benefit Neutral Neutral Contraindicated with Neutral eGFR <30 mL/min/1.73 m² SGLT2 inhibitors (oral) Intermediate to high No Loss (intermediate) Benefit: Benefit: canagliflozin, empagliflozin canagliflozin, dapagliflozin, empagliflozin, Benefit: canagliflozin, empagliflozin, dapagliflozin ertugliflozin See labels of individ- Unknown ual agents for dosage considerations for kidney function Glucose-lowering effect is minimal at eGFR <45 ml/min/ 1.73 m² and lower; continue or start for cardiovascular and kidney benefit if eGFR >20 ml/min/1.73 m². May continue until dialysis or transplantation Clinical considerations and adverse effects Gl side effects: mitigate with slow dose titration, extended-release formula- tions, and administration with food Potential for vitamin B12 deficiency: monitor and replete as appropriate DKA risk in individuals with insulin deficiency (rare in 12D): discontinue, evaluate, and treat promptly if sus- pected; be aware of predis-posing risk factors and clini cal presentations (including euglycemic DKA); mitigate risk with sick-day planning discontinue before sched- uled surgery (e.g., 3-4 days), during critical illness, fasting or during prolonged fasting Genital mycotic infections: mitigate risk with genital hygiene and avoid use in high-risk individuals Urosepsis and pyelonephri tis: evaluate individuals for signs and symptoms of urinary tract infections and treat promptly Necrotizing fascitis in the perineum (Fournier gangrene): rare; prompt treatment if suspected Intravascular volume deple tion: attention to volume status and blood pressure, particularly when ill or fast-ing; adjust other volume- contracting agents as appli-cable; monitor kidney func tion upon initiation Continued on. Give me dosage, how many times a day , titration, maximum dosages, how long and indication and contraindications of Metformin

From Ada 2026 guidelines

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Give me dosage, how many times a day , titration, maximum dosages, how long and indication and contraindications from Ada 2026 guidelines

Give me dosage, how many times a day , titration, maximum dosages, how long and indication and contraindications from Ada 2026 guidelines for SGLT2 AND make me a flowchart image like before

GLP-1 RAS (SQ; High to very high No Loss (intermediate to very high) Benefit: dulaglutide, semaglutide also available in oral formulation) CV effects Kidney effects Progression of Effect on MACE iraglutide, semaglutide (SQ and oral) Effect on HF CKD Dosing/use considerations MASH effects Benefit: Benefit for See labels of individ Benefit: semaglutide (SQ) kidney end ual agents for dosage points in CVOTs, driven considerations for semaglutide (SQ) kidney function No dose adjustment Neutral: exenatide once weekly, lixisenatide Dual GIP and Very high GLP-1 RA (SQ) No Loss (very high) Under investigation Benefit: tirzepatide by albuminuria outcomes: dulaglutide, liraglutide, semaglutide (SQ) Demonstrated benefit for progression of CKD for semaglutide (sa) Potential benefit for dulaglutide, liraglutide, or semaglutide Monitor kidney function when initiat- ing or escalating doses in individuals with kidney impair-ment reporting severe adverse Gl reactions See labels of individ Potential benefit ual agents for dosage considerations for kidney function No dose adjustment Monitor kidney function when initiating or esca lating doses in individu- als with kidney impair ment reporting severe adverse Gl reactions 12/33 Clinical considerations and adverse effects Thyroid C-cell tumors identi fied in rodents; human rele- vance not determined Provide guidance on discon tinuation prior to surgical procedures to mitigate potential for pulmonary aspiration with general anesthesia or deep sedation Pancreatitis: acute pancrea-titis has been reported, but causality has not been established; do not initiate if at high risk for pancreatitis, and discontinue if pancreati tis is suspected Biliary disease: evaluate for gallbladder disease if chole-lithiasis or cholecystitis is suspected; avoid use in at-risk individuals Ileus: reported, but risk level is not well established Diabetic retinopathy: close monitoring of retinopathy in those at high risk (older individuals and those with longer duration of T2D (≥10 years]) Nonarteritic anterior ische- mic optic neuropathy (NAION) reported (rare inci- dence); monitor for NAION during eye examinations Impact on drug absorption: orally administered drug ab sorption may be impaired during dose titration (includ- ing oral contraceptives) Gl side effects: counsel on potential for GI side effects; provide guidance on dietary modifications to mitigate Gl side effects (reduction in meal size, mindful eating practices [e.g., stop eating Continued Give me dosage, how many times a day , titration, maximum dosages, how long and indication and contraindications from Ada 2026 guidelines for GLP-1 RAS (SQ; AND Dual GIP and Very high GLP-1 RA (SQ) make me a flowchart image like before if possible both in same image

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DPP-4 inhibitors Intermediate (oral) No Neutral Neutral Neutral (potential risk: saxagliptin) Neutral Pioglitazone (oral) Dose adjustment required based on kidney function Unknown gastroparesis consider slower dose titra-tion for those experiencing Gl challenges; not recom-mended for individuals with Pancreatitis has been reported but causality has not been established; discontinue if High No Gain Potential benefit Neutral Increased risk Neutral Neutral Neutral (sitagliptin, saxagliptin, alogliptin) No dose adjustment required for linagliptin No dose adjustment Potential benefit required impairment due to potential for fluid retention Generally not recom-mended in kidney Glyburide: generally not recommended in Unknown CKD Glipizide and glimepiride: initiate conservatively to avoid hypoglycemia Sulfonylureas (2nd generation) (oral) High Yes Gain Use with caution in individ-uals at risk for hypoglyce-mia, particularly if in combi-nation with insulin once full], decreasing intake of high-fat or spicy food); pancreatitis is suspected Postmarketing concerns about joint pain (consider discontinuing if debilitating and other treatment options are feasible) and bullous pemphigoid (discontinue if suspected) reversible upon discontinuation Increased risk of HF and fluid retention; do not use in setting of HF Risk of bone fractures Bladder cancer: do not use in individuals with active bladder cancer, and use caution in those with prior history of bladder cancer; association observed with higher cumulative exposure (e.g., longer duration, higher doses) FDA Special Warning on in-creased risk of CV mortality based on studies of an older sulfonylurea (tolbutamide); glimepiride shown to be CV

DPP-4 inhibitors Intermediate (oral) No Neutral Neutral Neutral (potential risk: saxagliptin) Neutral Pioglitazone (oral) Dose adjustment required based on kidney function Unknown gastroparesis consider slower dose titra-tion for those experiencing Gl challenges; not recom-mended for individuals with Pancreatitis has been reported but causality has not been established; discontinue if High No Gain Potential benefit Neutral Increased risk Neutral Neutral Neutral (sitagliptin, saxagliptin, alogliptin) No dose adjustment required for linagliptin No dose adjustment Potential benefit required impairment due to potential for fluid retention Generally not recom-mended in kidney Glyburide: generally not recommended in Unknown CKD Glipizide and glimepiride: initiate conservatively to avoid hypoglycemia Sulfonylureas (2nd generation) (oral) High Yes Gain Use with caution in individ-uals at risk for hypoglyce-mia, particularly if in combi-nation with insulin once full], decreasing intake of high-fat or spicy food); pancreatitis is suspected Postmarketing concerns about joint pain (consider discontinuing if debilitating and other treatment options are feasible) and bullous pemphigoid (discontinue if suspected) reversible upon discontinuation Increased risk of HF and fluid retention; do not use in setting of HF Risk of bone fractures Bladder cancer: do not use in individuals with active bladder cancer, and use caution in those with prior history of bladder cancer; association observed with higher cumulative exposure (e.g., longer duration, higher doses) FDA Special Warning on in-creased risk of CV mortality based on studies of an older sulfonylurea (tolbutamide); glimepiride shown to be CV. Give me dosage, how many times a day , titration, maximum dosages, how long and indication and contraindications from Ada 2026 guidelines for DPP-4 inhibitors ,Pioglitazone (oral)AND Sulfonylureas (2nd generation) (oral) make me a flowchart image like before if possible both in same image

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