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tesamorelin if visceral fat is the primary target Starting dose 50% of standard adult dose, titrated up over 46 weeks based on IGF-1 response and side effect tolerance Administration subcutaneous injection, typically at bedtime to align with natural GH pulsatility 8-week reassessment IGF-1, fasting glucose, HbA1c, symptom review, body composition measurement Ongoing monitoring every 812 weeks

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Compared to traditional inhibitors that directly target activated NSPs, DPP1 inhibitors act on the upstream critical link of NSP activation, providing more comprehensive and fundamental inhibitory effects (Figure 1