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This focus on cardiovascular outcomes marks a shift in how these treatments are viewed, not just as blood sugar regulators but as potential life-saving medications for those with heart disease risks

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In the real-world setting, persistence with GLP-1 RA therapy has been found to range between 40% and 60% and between 34% and 67% at 180 and 360 days, respectively [23,24,25]

The KD improves insulin sensitivity in multiple ways, including by maintaining a negative energy balance, reducing fasting insulin concentrations and their diurnal fluctuations (which is attributable to its low-carbohydrate nature), and through direct effects of ketone bodies (among others, on insulin signalling) [11,144]