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7 In 1993, a German laboratory confirmed what Engs paper had implied: exendin-4 was not merely structurally similar to GLP-1 it was a high-potency agonist at the human GLP-1 receptor, stimulating the same cAMP signaling cascade in insulin-secreting beta cells and amplifying glucose-induced insulin secretion

Even in 2024, the Biden-era FDA noted that while no link was found, they could not definitively prove that a small risk did not exist