As the site of GLP-1 secretion, the stability of the gut microbiota itself affects the peripheral circulation of GLP-1, and their interaction forms a robust regulatory pathway
This physiological change contributes to improved postprandial glucose control and enhanced satiety, but it also underlies many of the gastrointestinal side effects associated with the medication
However, if that same individual comes in and they go, you know, I have sleep apnea, my knees hurt, I'm developing pre-diabetes, or a woman has PCOS, infertility and so forth now there's harm to their health because of the excess body fat, and we call that clinical obesity
Since the treatment algorithm put forth by the ADA says always start with metformin first, some professionals and people with diabetes are asking, why start with metformin and not with one or both of these two classes of medications