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however, randomized controlled trials and a large international cohort study have shown no increases in thyroid cancer risk in humans.[7779] Isolated study findings have also raised concerns about ocular adverse events, including retinopathy and non-arthritic anterior ischemic optic neuropathy (NAION).[11, 80] However, to date, meta-analyses have failed to find associations between GLP-1RAs and NAION, and only albiglutide, a GLP-1RA discontinued in 2017, has been associated with an increased risk of retinopathy.[80, 81] In adults 66 years and older with diabetes, a cohort study found a two-fold increase in risk for neovascular age-related macular degeneration in those using GLP-1RAs for one year or more.[82] Accessibility Despite the expanding indications and potential therapeutic benefits of GLP-1RAs, disparities in cost-related access may hinder their utilization in populations that stand to benefit the most.[83] In the U.S., individuals identifying as Hispanic and non-Hispanic Blackgroups with higher obesity prevalencedemonstrate significantly lower initiation rates of GLP-1RAs compared to individuals identifying as White.[83, 84] Additionally, individuals enrolled in Medicaid, Medicare, or lacking insurance are less likely to initiate GLP-1RA therapy relative to those with private insurance coverage

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HFD-induced GLP-1 resistance was associated with reduced intestinal Glp1r expression and defective GLP-1induced activation of murine enteric neuron circuits linked to CNS GLP-1 action (34)