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At present, there is a balance payers must achieve across a variety of influencing factors on whether to cover GLP-1s (see Figure 1)
Exenatide had 53% homology with GLP-1, had strong binding ability with GLP-1 receptor and was not easily degraded by DPP-4
Additionally, GLP-1 regulates insulin secretion from pancreas -cells in both normal and disease conditions [27]
Expert consensus suggests considering pharmacotherapy when there is: Significant weight regain from nadir weight BMI 27 kg/m with obesity-related comorbidities or BMI 30 kg/m Absence of anatomical complications requiring surgical revision Adequate adherence to nutritional and behavioral recommendations Patient willingness to engage in long-term pharmacotherapy The American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) guidelines emphasize that pharmacologic therapy should complement, not replace, lifestyle interventions and ongoing bariatric surgical follow-up
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The functional significance of the mitochondrial involvement in GABA biosynthesis is not well understood but it may provide additional possibilities for regulatory mechanisms to operate
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