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Reduced efficacy concerns GLP-1 receptor agonists are designed to work at specific doses to achieve optimal receptor activation (saturation) and to provide full therapeutic effect

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It increases the risk of: Type 2 diabetes MASLD (metabolic dysfunction-associated steatotic liver disease, formerly called NAFLD) Cardiovascular disease The loss of estrogen also accelerates sarcopenia, the loss of lean muscle mass, which further slows metabolism and reduces energy expenditure

See a representative review on PubMed for more detail: PubMed review of l-carnitine effects