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More serious adverse effects that require monitoring include: Pancreatitis (treatment should be discontinued immediately if suspected) Gallbladder disease (cholelithiasis and cholecystitis) Diabetic retinopathy complications (particularly with rapid HbA1c reduction in patients with pre-existing retinopathy) Acute kidney injury (secondary to dehydration from gastrointestinal side effects) Increased heart rate Hypoglycaemia (particularly when used with insulin or sulphonylureas) Understanding the expected side effect profile helps patients distinguish between typical medication responses and symptoms that may warrant further medical evaluation