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Dulaglutide has been shown to reduce hyperglycemia-induced endothelial injury, potentially by preserving sirtuin 1 (SIRT1) levels and curbing mitochondrial fission [118], as well as via the downregulation of the NLR family pyrin domain containing 3 (NLRP3) inflammasome [119]

These studies reinforced a pro-atherogenic role for macrophage LPL

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As these secondary events may be unpredictable and the mortality rate for MALA approaches 50%, Metformin has been contraindicated in moderate and severe renal impairment

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