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Of particular concern for patients with diabetes, berberine may potentiate the glucose-lowering effects of antidiabetic medications, including insulin, sulfonylureas, and meglitinides, potentially increasing hypoglycemia risk

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According to NICE guideline NG28, GLP-1 receptor agonists should be considered when: Triple therapy (metformin and two other oral drugs) is not effective, not tolerated, or contraindicated The patient has a BMI 35 kg/m (or lower in people of Black, Asian and other minority ethnic groups) and specific obesity-related comorbidities The patient has a BMI 40% reduction in non-HDL cholesterol GLP-1 receptor agonist for glycaemic control and weight management (with secondary lipid benefits) Ezetimibe if non-HDL cholesterol reduction is insufficient Lifestyle interventions addressing diet, exercise, and weight Monitoring and follow-up are essential components of cholesterol management