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Sitagliptin, a dipeptidyl peptidase-4 inhibitor, was selected as an active-comparator placebo proxy because it was recommended in clinical guidelines as a second-line glucose-lowering therapy, had a similar high cost to the study drugs, showed no effect on cardiovascular outcomes in a large randomized controlled trial and has been validated as a placebo proxy in prior claims-based research 20,41

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It is also important to address a potential concern

The upper arm site should only be used when adequate subcutaneous tissue is present, as insufficient tissue depth may result in inadvertent intramuscular injection, potentially altering absorption kinetics