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Moreover, functional MRI studies have demonstrated impaired connectivity within the default mode network in T2DM patients

smaller, more frequent meals may reduce reflux Identify and avoid personal trigger foods (commonly citrus, tomatoes, chocolate, caffeine, alcohol, and fatty foods) Remain upright for at least 23 hours after eating Elevate the head of the bed by 1020 cm using blocks (not just pillows) Smoking cessation is strongly advised, as smoking exacerbates reflux Alternative acid suppression therapies: H2-receptor antagonists (such as famotidine) may be considered, though they are less potent than PPIs These can be taken in the evening, completely separated from morning Rybelsus dosing Alginate-containing antacids (e.g., Gaviscon) form a protective barrier and can be used as needed, taken at least 30 minutes after Rybelsus These are particularly useful for nocturnal symptoms Reviewing the need for ongoing PPI therapy: NICE guidance recommends regular review of PPI use , with consideration of step-down therapy or stopping treatment in appropriate patients Some patients may manage with on-demand PPI use rather than daily maintenance A trial period without PPI (under medical supervision) may reveal whether ongoing therapy is necessary Addressing GLP-1-related GI effects: Nausea and reflux-like symptoms from Rybelsus often improve after 48 weeks as tolerance develops Slower dose escalation may reduce GI side effects Taking Rybelsus with the smallest possible volume of water may help Alternative diabetes therapies: If GI side effects or medication timing proves unmanageable, discuss alternative options with your diabetes team Once-weekly subcutaneous semaglutide (Ozempic) or other GLP-1 receptor agonists avoid the absorption complexities of oral therapy Other oral diabetes medications with different mechanisms may be appropriate depending on individual circumstances Any changes to your acid reflux management or diabetes therapy should be made in consultation with your healthcare team, ensuring both conditions remain adequately controlled whilst minimising medication burden and interaction risks

Hellstrm, Uppsala University, Sweden I

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doi: 10.1002/cam4.1670 100 KaoJ-KWangSCHoLWHuangSWLeeCHLeeMSet al

GLP-1 medications make it dramatically easier to adopt healthier eating habits, increase physical activity, and build muscle