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In principle, sphingomyelin can be hydrolyzed by different enzymes: neutral SMase, acidic SMase, and secreted forms of SMases [120]
Although these trials primarily enrolled individuals with relatively low DKD risk and were not designed to evaluate kidney outcomes specifically, exploratory analyses consistently indicated slower kidney disease progression across diverse eGFR and albuminuria levels [39-44]
Zepbound, another injectable with a dual-action mechanism targeting GLP-1 and GIP receptors, has demonstrated the highest weight loss efficacy among available medications, achieving up to 20.9% body weight loss
Manufacturers and lactation experts recommend caution due to theoretical risks, unknown infant metabolic effects, and lack of safety data in vulnerable populations
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