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Renal Function : Both Januvia and metformin are primarily excreted by the kidneys, so their use may require adjustments in patients with impaired renal function

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Glutathione synthetase deficiency is an autosomal recessive disorder that was first diagnosed in 1970 in a teenager with a slowly progressive neurologic disorder and markedly elevated excretion of 5-oxoproline in the urine, as well as a history of unexplained jaundice at birth and a history of chronic metabolic acidosis

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These combined effects help improve glycaemic control in people with type 2 diabetes