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Insulin sensitivity and energy metabolism Berberine increases insulin receptor expression, enhancing the bodys response to insulin and facilitating glucose uptake into cells, says Jennifer Agha-Khan, MS, RDN, at Pendulum Therapeutics

Topiramate increases kidney stone risk and metabolic acidosis, while both drugs require monitoring in patients with renal disease

There is no week-by-week titration

In add-on therapy, starting with an SGLT2 inhibitor may be preferable, especially for patients with established diabetic kidney disease, owing to its well-documented benefits in reducing intraglomerular pressure and albuminuria