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DPP-4 can also have signaling functions via interactions with the extracellular matrix (90), and it was therefore speculated that the DPP-4 inhibitor might have improved insulin sensitivity by interfering with this process in some way rather than by blocking the enzymatic activity per se (79, 89)

The paper also notes substantial administrative censoring around five years, which limits the precision of later survival estimates even though the models extended to ten years

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Manufacturing capacity and supply scalability pose additional risks, especially during the early stages of commercialization

Unfortunately, clinical trials carried out so far have not shown such changes in the human gut, not only because it is difficult to determine the length (ranging from 3 to 8 m) of the small intestine in adults, but also the direct clinical manifestation of reduced intestinal diameter and slow transit is constipation, a common symptom with many causes