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Strengths Acts via multiple pathways (GLP-1, AMPK, microbiome) Has existing human data showing reductions in fasting glucose, HbA1c, lipids Support receptor expression and islet health Limitations Low absorption and bioavailability Gastrointestinal discomfort is common (diarrhea, cramping)

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Over the maximum follow-up of ~30 years, there were 7069 events (1937 ASCVD, 2109 heart failure, 3288 CKD and 4785 deaths)

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