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It means primary enforcement responsibility sits with the state

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Comparative study on efficacy of empagliflozin versus sitagliptin, as an add-on therapy to metformin in Type 2 diabetic patients, J Pharm Bioallied Sci (2024) A comparison of the effects of empagliflozin and sitagliptin, when combined with metformin, on lipid levels in patients with Type 2 diabetes: A clinical investigation, Cureus (2023) Highlights of prescribing information, Merck Sharp & Dohme Corp