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For type 2 diabetes, NICE-recommended alternatives include metformin (first-line), SGLT2 inhibitors, DPP-4 inhibitors, and insulin therapy, each with distinct mechanisms and side-effect profiles
And when these bacteria digest resistant starch, the butyrate they produce doesn't just boost GLP-1, it also helps reduce inflammation and support brain health via the gut-brain axis
However, GLP-1s can come with challenges, including gastrointestinal side effects, risk of micronutrient deficiencies, muscle and bone loss, poor long-term follow through with weight regain if stopped, and high costs
However, for patients undergoing frequent UDS testing, selecting an agent least likely to cause false-positives would be an important consideration to help minimize adverse consequences to patients from potentially misinterpreted results
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