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Second, the evidence base is vulnerable to selective reporting and publication bias, and the exclusion of non-English and unpublished/grey literature may preferentially omit null findings

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Important safety considerations include contraindications in patients with personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2, caution in those with a history of pancreatitis, increased risk of gallbladder disease, potential for acute kidney injury with dehydration, and possible worsening of diabetic retinopathy with rapid glycemic improvement