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Efficacy and safety of once-weekly semaglutide versus once-daily insulin glargine as add-on to metformin (with or without sulfonylureas) in insulin-naive patients with type 2 diabetes (SUSTAIN 4): a randomised, open-label, parallel-group, multicentre, multinational, phase 3a trial. The Lancet Diabetes & Endocrinology, vol

Nutritional shifts during reduced intake may also play a role, especially if intake becomes insufficient

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It's used off-label by athletes and in clinical research