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Although potentiation of SP activity has been postulated to underlie the pathophysiology of nasopharyngitis or neurogenic inflammation occasionally reported with use of DPP4 inhibitors, SP is also rapidly cleaved by angiotensin-converting enzyme and neutral endopeptidase, and levels of intact vs cleaved SP are very low and difficult to quantify in vivo

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Lifestyle intervention remains foundational: weight loss, diet, physical activity these are the first line not only for glucose control but also liver outcomes