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In contrast, no benefits on the rate of decline in glomerular filtration rate have been seen in trials of DPP-4 inhibitors, perhaps because the renal actions of DPP-4 inhibitors are primarily mediated by potentiation of SDF-1, not GLP-1

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At the same time, payer policies often require discontinuation of GLP-1 therapy when a patients BMI drops below a set threshold, inadvertently triggering a frustrating cycle of weight loss and regainthe so-called yo-yo effect. This not only impacts ongoing adherence and persistence but also undermines the long-term cost-effectiveness of these therapies for healthcare systems