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Larger molecules like dulaglutide and albiglutide, which are fusion proteins with albumin or Fc domains, have molecular weights approaching or exceeding 60,000 Da, rendering them virtually impermeable to the BBB through classical routes

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The difference in efficacy may appear modest on the surface, but individual responses vary significantly based on genetic predisposition and metabolic factors

Chen QH, Munoz E, Ashong D (2024b) Insight into recent advances in degrading androgen receptor for castration-resistant prostate cancer

Second, medicines are chosen by diabetes type and other health issues: type 1 always needs insulin (preferably with a continuous glucose monitor or hybrid pump), while type 2 usually starts with metformin plus lifestyle changes and, if more help is needed, adds a GLP-1 or SGLT2 drug (especially when heart, kidney, or weight problems exist) before considering insulin

Patients should report any worsening depression, increased anxiety, or suicidal thoughts immediately