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The REWIND cardiovascular outcome trial also revealed that dulaglutide administration resulted in inferior ocular outcomes, leading to an increased need for interventions such as photocoagulation, anti-vascular endothelial growth factor (VEGF) therapy, or vitrectomy compared to placebo recipients [38]

The lesson is that absolute bioavailability percentage is not the only number that matters

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GLP-1 receptor agonist medications solve this by using modified versions of the GLP-1 molecule that resist enzymatic breakdown

Science 249 (4975), 14381441