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If necessary, patients may transition to a more potent medication or explore whether surgical options could provide longer-term stability

"This means that the reason for higher GLP-1 secretion is not because the surgery changes the hormone production by the gut, but it is because nutrient digestion and absorption happens in a different place in the gut and that causes higher levels of GLP-1 and PYY," says Gribble

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MET-097i has shown roughly 10% weight loss at just under three months

Adding Zepbound to the regimen is reasonable, and several published case series have reported successful weight loss in this population

this difference may result from a ~5x stronger effect produced by GLP-1 analogs, compared to DPP-4 inhibitors (Charbonnel & Cariou, 2011) No change in weight Contraindications: type I diabetes (these patients lack pancreatic beta cells) diabetic ketoacidosis (it would not be effective for treating this condition) an association between DPP-4 inhibitors and heart failure has been observed for two members of this drug class in patients with type 2 DM and atherosclerosis