Conclusions Evidence accrued so far suggest that GLP-1RA could exert a modest renal benefit alongside CV protection, justifying its place as second-line drug in patients with T2D and CKD not achieving glycemic control with SGLT-2i and metformin according to KDIGO guidelines [87]
Management of heart failure should be initiated, and discontinuation or dose reduction of Avandia must be considered in such cases
New GLP-1RAs and combinations, including oral options and multi-agonists like retatrutide and maritide, show promise
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It was originally developed to treat growth hormone deficiency and has since gained widespread use in anti-aging and performance medicine
We furthermore thank Luise Krauth-Siegel for helpful discussions and Tobias Dick and Bruce Morgan for reading an initial version of the manuscript and suggestions