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This washout period allows sympathomimetic effects to clear and prevents acute cardiovascular strain during the transition phase

Thats why the FDA gives it a boxed warning

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Blood glucose improvements often occur within 12 weeks, whilst HbA1c reductions become measurable by 1216 weeks

Immunoglobulin-A levels and expression of antimicrobial peptides are gastrointestinal markers that provide insight into gut immunity and potential etiology of gut-centric disease processes 31

CGRP-positive nerve fibers that innervate the airways originate from the trigeminal, nodose-jugular and dorsal root ganglia [138]