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This trial establishes the superiority of flexible-dose adjustment of oral semaglutide, which is usually followed in clinical practise in comparison with sitagliptin.[19] PIONEER 4 compares the efficacy and safety of oral semaglutide with a subcutaneously injected GLP-1 receptor agonist, liraglutide, and placebo in patients with T2DM uncontrolled on background metformin with or without an SGLT2 inhibitor

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Both require weekly injections (or daily oral formulations), though injection versions generally produce more reliable absorption