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They are now commonly used when: Metformin alone is no longer enough Weight gain is contributing to worsening glucose control There is a need to minimise hypoglycaemia risk Someone has existing cardiovascular disease or multiple risk factors For many people, GLP-1 therapy can delay or reduce the need for insulin, or allow insulin doses to be kept lower and safer

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doi: 10.1111/cas.13701 232 YangWHDingCCSunTRupprechtGLinCCHsuDet al

CJC-1295/Ipamorelin introduced dual-pathway activation: CJC-1295 extends the half-life of the GHRH signal from minutes to hours, while Ipamorelin simultaneously activates the ghrelin receptor, amplifying and sustaining the GH pulse