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It is a single synthetic chain with agonist activity at three receptors, the GIP receptor and the glucagon receptor as well as the GLP-1 receptor, and its published pharmacology is dominated by the interaction between those activities rather than by any one of them
This suggests that while oral forms provide gastroprotective effects through local action, systemic therapeutic benefits require higher concentrations
Compliance matters for outcomes, and simpler protocols generally produce better adherence
Their value is as an adjunct within a broader metabolic plan supporting liver function while other interventions drive the primary metabolic change
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