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Drug initiation (index date) was defined as the first recorded prescription for a medication within a given drug class, with no prior use of that class in the preceding 1 year, a washout period commonly used in target trial emulation to ensure inclusion of new users and minimize potential biases related to prior exposure.15, 16, 17 DPP4is were selected as active comparators because they were recommended as second-line glucose-lowering therapies in clinical guidelines during the study period 18 and were commonly used as comparators in studies evaluating the safety of GLP-1RAs
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