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President Trump recently announced a deal with drugmakers to expand access to GLP-1 drugs to Medicare patients starting in 2026

Currently, there are ten classes of orally available pharmacological agents to treat T2DM: 1) sulfonylureas, 2) meglitinides, 3) metformin (a biguanide), 4) thiazolidinediones (TZDs), 5) alpha glucosidase inhibitors, 6) dipeptidyl peptidase IV (DPP-4) inhibitors, 7) bile acid sequestrants, 8) dopamine agonists, 9) sodium-glucose transport protein 2 (SGLT2) inhibitors and 10) oral glucagon like peptide 1 (GLP-1) receptor agonists

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This case underscores that standard fasting protocols may not ensure gastric emptying in patients on GLP-1 RA therapy, particularly during medication up-titration or in those with coexisting gastrointestinal motility disorders

We propose that these changes in monotreme GLP-1 are the result of conflicting function of this peptide in metabolic control and venom