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For someone with significant insulin resistance, the same workaround could backfire

He told us that: This is an important trial which reinforces the concept that patients with the [symptoms] of heart failure syndrome can be further benefited by administration of a drug that was originally developed to reduce blood sugar and has now emerged as an important way to reduce cardiovascular and heart failure events, while simultaneously improving patients functional capacity and sense of well-being. It also promotes weight loss, and was Studies have found that it may also lower cardiovascular risks for people with obesity

J Pers Med 13(2):252

The difference lies in professional oversight and accountability