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doi: 10.1038/s41582-019-0155-7 27 ErlichJ

Acute exercise temporarily increases DPP-4 activity (likely evolutionary adaptation to manage incretin hormones during physical stress), but chronic regular exercise appears to reduce baseline DPP-4 expression

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Vomiting and Diarrhea: Some people may experience vomiting or diarrhea, especially in the first few weeks of treatment

[1] This combined approach leads to improved glycemic control and substantial weight loss in clinical trials