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Ahrn B, Masmiquel L, Kumar H et al (2017) Efficacy and safety of once-weekly semaglutide versus once-daily sitagliptin as an add-on to metformin, thiazolidinediones, or both, in patients with type 2 diabetes (SUSTAIN 2): a 56-week, double-blind, phase 3a, randomised trial

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Also, adding water after initial reconstitution introduces a second opportunity for contamination

You also get L-carnitine from red meat, poultry, fish, and dairy