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These shifts may come and go at first, especially while doses are still low, but often become more consistent as treatment continues and doses go up

[3] Subsequently, activation of secondary pathways, including protein kinase A (PKA) and Epac2, alters cell ion channel activity, causing elevated levels of cytosolic Ca 2+ that enhance exocytosis of insulin-containing granules

Some early data suggests it might do the opposite

The FDA nod, which the companies announced on Friday, is specifically for the reduction of risk of sustained decline in estimated glomerular filtration rate (eGFR), end-stage kidney disease and cardiovascular death and hospitalization in adults with CKD at risk of progression