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Research has established that ATF4 directly induces the transcription of PDE4D, a phosphodiesterase that degrades intracellular cAMP, thereby blunting the signaling fidelity of the GLP-1R (Lee et al., 2023)

This is not a perfect system, but it catches the most visible problems

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You see, per the FDA regulations, when a drug is on the official FDA Drug Shortage list (which our GLP-1 friends all were), compounding pharmacies are legally allowed to prepare essentially a copy of that drug in order to meet the patients needs

Next, lets look at why this is happening