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Metabolic alterations, such as chronic hyperglycemia, insulin resistance, and increased metabolism of free fatty acids, result in oxidative stress, inflammation, advanced glycation end product formation, and abnormalities in calcium homeostasis, leading to apoptosis, fibrosis, and endothelial dysfunction [21], which represents the main initiating factor in the pathogenesis of diabetic vascular complications

The relative contribution of metabolic versus direct antiinflammatory effects of GLP-1 medicines to reduce liver inflammation remains to be clarified

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Large trials show fewer heart attacks and strokes with GLP-1 use through improved endothelial function, reduced oxidative stress, and better nitric oxide availability. If other benefits manifest at lower doses, cardiovascular protection likely does too

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