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3,4 It can sometimes coexist with other musculoskeletal disorders, such as ossification of the ligamentum flavum (OLF), diffuse idiopathic skeletal hyperostosis (DISH), and ankylosing spondylitis

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Factors influencing individual results include: Baseline metabolic health and insulin resistance Adherence to dietary and physical activity recommendations Genetic predisposition to weight loss Concurrent medications that may affect weight Psychological factors and eating behaviours Patients should maintain realistic expectations: whilst significant abdominal fat reduction is achievable, GLP-1 therapy will not produce a flat stomach or eliminate all belly fat, particularly in those with substantial weight to lose

NICE Guidelines on Using DPP-4 Inhibitors in Type 2 Diabetes NICE NG28 recommends DPP-4 inhibitors as second- or third-line therapy alongside metformin, particularly when hypoglycaemia risk or weight gain is a concern, but prioritises SGLT-2 inhibitors in patients with cardiovascular disease or chronic kidney disease