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The few studies that have used those tools, including the Langer data, do not show disproportionate muscle loss

Their primary mechanisms of action include: Enhancing insulin secretion from pancreatic beta cells in a glucose-dependent manner, which generally reduces the risk of hypoglycaemia (though this risk increases when combined with insulin or sulfonylureas) Suppressing glucagon release from pancreatic alpha cells, thereby reducing hepatic glucose production Slowing gastric emptying , which prolongs satiety and reduces postprandial glucose excursions Acting on appetite centres in the hypothalamus to reduce hunger and food intake These combined effects lead to improved glycaemic control in people with type 2 diabetes and significant weight reduction in those prescribed these medications for obesity management

While smoking status remained unknown for most, 90% of the participants, 7.7% of the overall cohort were classified as never smokers and 2.2% as current or former smokers

Metformin, a first-line T2DM treatment, affects the gastrointestinal tract by altering glucose uptake, GLP-1 secretion, gut microbiota, and immune response [33, 34], but it rarely causes bowel obstruction