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This may be similar to patients with diabetes with lower HbA1c having less change than those with higher HbA1c with anti-diabetes medications which dont cause hypoglycemia

Rousseau, E

This mechanism of promoter binding leads to increased DPP-4 transcription [33]

Coveleskie K, Kilpatrick LA, Gupta A, et al
GLP-1 drugs are widely used for diabetes and weight loss, but their potential to transform healthcare is growing

Anti-inflammatory mechanisms may play a role here, as chronic inflammation contributes to glomerular injury and tubulointerstitial fibrosis
