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Some studies suggest D-mannose may play a useful role as a prebiotic that may help by stimulating the growth of good bacteria

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missed doses reduce the sustained inhibition of DPP-4 and blunt glycaemic control Concomitant medications : Combining a DPP-4 inhibitor with metformin or an SGLT-2 inhibitor generally produces additive HbA1c reductions Lifestyle factors : Diet, physical activity, and body weight all influence overall glycaemic control and can either enhance or diminish the pharmacological effect of gliptins Regular HbA1c monitoring approximately three months after initiating or adjusting treatment, then every three to six months until stable, and six-monthly thereafter is recommended in line with NICE NG28 to assess ongoing response