DPP-4 inhibitors were not included in the two tiers because their effectiveness on glycemic control is lower than or equivalent to first- and second-tier agents, as well as for less clinical evidence and relative expense
Theres also the question of how GLP-1 agonists would integrate with existing treatment models
Mechanism of Action 5-Amino-1MQ exerts its metabolic effects primarily through competitive inhibition of nicotinamide N-methyltransferase (NNMT), an enzyme belonging to the methyltransferase superfamily that is expressed in multiple tissues including liver, adipose tissue, skeletal muscle, kidney, and brain, with particularly high expression in visceral (abdominal) adipose tissue - the fat depot most strongly associated with metabolic disease
However, an earlier doseresponse study (Moinard et al
If you have spent any time inside the longevity or biohacker side of the internet over the past two years, you have heard the opposite story