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N Engl J Med 2021;384(12):111324

Not only would patients not receive the intended dose of the potent painkiller, but isoproterenol hydrochloride is associated with a risk of life-threatening abnormal heart rhythms

Mechanisms identified include: increased cardiac utilization of ketones increased autophagy (recycling of intracellular components)l decreased inflammation & oxidative stress improved mitochondrial function decreased intracellular Ca & Na overload decreased fibrosis improved myocardial diastolic function decrease myocardial hypertrophy Indications: Type 2 diabetes Adjunct therapy in patients not meeting their glycemic goal with other agents (e.g