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The differences seen by income groups may be influenced by both the increased use of GLP-1 RAs during the study period (Rodriguez et al., 2023) and the change in clinical guidelines during the period (Summary of Revisions, 2020)

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Adding glucagon receptor (GCGR) agonism to the dual GLP-1R/GIPR profile introduces a mechanism that neither of the predecessor compounds can produce: direct upregulation of energy expenditure through hepatic and thermogenic pathways

In particular, metformin is associated with a low concentration of B12 and a higher risk of B12 deficiency, but the exact mechanism remains elusive