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However, for patients with very high blood sugar at diagnosis (HbA1c above 10 percent) or symptoms of hyperglycemia, insulin may be started right away, bypassing the usual stepwise approach

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Hernandez AF, Green JB, Janmohamed S, et al Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double‐blind, randomised placebo‐controlled trial

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