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You should not use these medications if you or a family member has a history of medullary thyroid carcinoma or if you have multiple endocrine neoplasia syndrome type 2
First, unlike other DPP-4 inhibitors that are excreted largely in urine, linagliptin is mainly eliminated by a biliary route [131] and therefore does not require dose adjustment in patients with kidney disease [132, 133]
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Patients should be cautious, as its prolonged effects are not well-studied
Adherence to dietary and physical activity recommendations is often unmeasured, making it difficult to isolate medication effects from lifestyle factors
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