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They mimic the action of GLP-1 to reduce glucose levels through stimulation of insulin secretion and inhibition of glucagon secretion

Several factors likely contribute: the peptide's very short half-life, difficulty crossing the blood-brain barrier in meaningful quantities, small study sizes, differing endpoints (subjective reports versus objective polysomnography), and the placebo-sensitive nature of insomnia outcomes

Ghareghani M, Dokoohaki S, Ghanbari A et al (2017a) Melatonin exacerbates acute experimental autoimmune encephalomyelitis by enhancing the serum levels of lactate: a potential biomarker of multiple sclerosis progression

The idea of using a metric such as the clinically meaningful change can be applied to assess whether the outcome is not only statistically relevant, but would be meaningful to a person with a particular disease

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Mole changes warrant careful monitoring see the Melanotan-2 side effects guide