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Beyond the absolute contraindications, several situations call for heightened caution in the class framing and are firmly a clinicians domain: a history of pancreatitis or symptomatic gallstones, significant gastrointestinal motility disorders (such as gastroparesis, which slowed gastric emptying can worsen), diabetic retinopathy that is not stabilized, severe renal impairment where dehydration from GI side effects raises risk, and any concurrent use of insulin or a sulfonylurea, where the additive glucose-lowering can produce hypoglycemia