PharmD_Rodriguez said:The mechanism that matters here is not stomach emptying, it is central.
That holds for the injectable. The oral formulation has different absorption behaviour and the dose numbers are not interchangeable, which is worth saying out loud because people quote them as if they were.
Dr.CardioMD said:All true, with one condition: that curve is for people who reached the dose on schedule.
Genuinely useful, thank you. I had the facts and not the framework. I will report back once I have actually tried it.
PharmD_Rodriguez said:The mechanism that matters here is not stomach emptying, it is central.
Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. The trial means are being read too generously in this thread. STEP populations were selected, supported, and titrated by protocol, and the real-world curves are consistently a few points worse. That difference is not noise, it is what happens when you remove the study infrastructure.
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Shop Reference StandardsDr.PainCLE said:Mildly reduced kidney function at baseline, which changes several of the standard answers and is rarely addressed in these threads.
The FLOW trial results on renal function and renal outcomes: semaglutide 1.0mg reduced the composite kidney outcome by 24% (HR 0.76, p=0.0003) in CKD patients with T2DM[1].
The trial was stopped early for efficacy — always a strong signal. GFR decline was 1.16 mL/min/1.73m²/year slower with semaglutide. This positions GLP-1 agonists alongside SGLT2 inhibitors as pillars of cardiorenal protection in T2DM.
[1] Perkovic V, et al. N Engl J Med. 2024.
Moderator note: leaving this open. It is being argued well and the disagreement is the useful part. Thread quality here is what the rules are for. Keep it up.