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Alogliptin neither increased cardiovascular morbidity or mortality, nor worsened pre-existing heart failure, including in those patients with a very recent acute coronary syndrome, after a median duration treatment of 18 months [106, 107]

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Although physical exercise improves insulin resistance, it may not be appropriate for patients with active liver disease, while restrictive diets may aggravate the protein-calorie malnutrition often found in these patients.4 Studies are needed to determine what changes in lifestyle could benefit these patients

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