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The mechanism of action involves several complementary pathways

Semaglutide added to basal insulin in type 2 diabetes (SUSTAIN 5): a randomized, controlled trial

[33, 34, 35, 36] Mechanism: Typically pre-renal, occurring in the setting of volume depletion from GI losses (nausea, vomiting, diarrhea, reduced oral intake) More frequently seen at higher, obesity-level doses Although generally reno-protective long term, post-marketing data describe acute rises in creatinine following days to weeks of significant GI symptoms Risk factors: Underlying chronic kidney disease Concomitant use of ACE inhibitors, ARBs, diuretics, or SGLT2 inhibitors ED Management: IV fluids Hold GLP-1 and contributing medications Usually reversible with supportive care Future Directions GLP-1 receptor agonists are rapidly evolving beyond their original indications in diabetes and obesity

Prescribing and lifestyle side by side, not built to work as one More pressure

Physicians also screen for exclusion criteria including pregnancy plans, certain gastrointestinal conditions, and drug interactions that could affect safety or efficacy