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A critical clinical consideration, highlighted in the 2026 ADA guidelines and other recent reviews, is that while many newer agents (GLP-1 RAs, SGLT2 inhibitors, DPP-4 inhibitors) have a low intrinsic risk of hypoglycemia as monotherapy, this risk increases substantially when they are combined with insulin or sulfonylureas

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In contrast, there was a significant increase in the average concentration of cysteine from 0.37 to 0.99 nmol/mg of protein and of glutathione from 8.7 to 15.6 nmol/mg of protein in lymphocytes 2 to 3 hr after ingestion of OTC

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