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Over time, especially when stored improperly or kept past its expiration or beyond-use date, the active ingredient can degrade and become less effective

Wei, Y., Palacios Araya, D

These are studied as standalone compounds

Dipeptidyl peptidase 4 inhibitor sitagliptin maintains -cell function in patients with recent-onset latent autoimmune diabetes in adults: one year prospective study

it often signals that your body has achieved a new equilibrium and may benefit from a dose increase

So even without significant weight gain, not weight, not because you're eating more or moving less, there's an increase in visceral fat being deposited