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The American Diabetes Associations position that metformin should remain the first-line treatment for most type 2 diabetes cases is partly driven by this cost advantage at roughly $120 per year versus over $11,000 annually for Rybelsus, metformins modest efficacy is justified for 90% of people starting type 2 diabetes treatment

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Dosage and Cumulative Exposure Higher maintenance doses (e.g., 2.4 mg) and long-term use lead to greater drug accumulation in the body, which can extend the time required for levels to fall below detectable limits