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GLP-1 receptor agonist medications (including semaglutide, dulaglutide, liraglutide, exenatide, and lixisenatide) are typically considered for type 2 diabetes when: Triple therapy with other diabetes medications is not effective, not tolerated, or contraindicated The person has a BMI 35 kg/m (adjusted by 2.5 kg/m for people from South Asian, Chinese, other Asian, Black African, or African-Caribbean backgrounds) and specific weight-related psychological or medical problems A lower BMI threshold may be appropriate if weight loss would benefit other obesity-related comorbidities Insulin would not be appropriate or acceptable to the person Treatment is usually continued only if there is a beneficial metabolic response (reduction in HbA1c and weight) after 6 months
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Semaglutide should be used in combination with lifestyle changes, including a healthy diet and exercise
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however, subsequent evidence indicates that most GLP-1mediated hepatic effects are indirect, driven by reductions in caloric intake, body weight, and insulin resistance [77]
Regulatory and quality concerns : Enema equipment may fall under MHRA medical device regulations, but coffee solutions are not licensed medicines
