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Cohort identification The background population of patients with diabetes mellitus was selected among Italian citizens residing in Veneto who had been eligible beneficiaries for at least 1 year between January 1st, 2011 and September 30th, 2018 or time of death

Since these medications work in different areas of the body, they do not directly interfere with each others main actions

Metabolic issues: Feeling constantly cold, chills, or a low body temperature (signs of metabolic acidosis) Severe gastrointestinal changes: Persistent diarrhea, vomiting, or a total loss of appetite Systemic changes: Unexplained tiredness, a fever or other signs of infection, unusual bleeding, bruising, or long-term concerns like osteoporosis In general, higher doses of topiramate are associated with an increased risk of adverse reactions