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A big part of why branded semaglutide costs so much is due to the corporate greed of many pharmaceutical companies

This review aimed to evaluate the association between PPI-dependent alterations in the intestinal flora and resultant digestive diseases

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Thus, in perfect agreement with the recent ADA-EASD consensus report [6], we also encourage the adoption of GLP-1RA plus SGLT2i combination therapy in T2DM patients with established ASCVD (coronary artery disease, cerebrovascular disease, or peripheral arterial disease) or multiple risk factors for ASCVD (i.e., age 55 years, obesity, dyslipidemia, hypertension, current tobacco use, left ventricular hypertrophy, and/or proteinuria) whose HbA1c remains suboptimal despite initial treatment with only one of these agents

However, its worth keeping in mind that the starting dose is not a therapeutic dose for weight loss