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Why do people assume these medications are equivalent

European Medicines Agency

[16] DPP-4 inhibitors (such as sitagliptin), which enhance incretin activity through a different mechanism Insulin therapy, particularly if oral agents and other injectables are unsuitable Traditional agents like metformin, sulphonylureas, or pioglitazone, depending on individual circumstances NICE guideline NG28 recommends individualised treatment approaches based on HbA1c targets, cardiovascular risk, renal function, and patient preferences

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Additionally, while the net effect on the heart is positive, the medication can cause a slight increase in resting heart rate