Purely from a value perspective, we should be even more underallocating here, but I feel that we might be betting on Novo Nordisk a bit too much
The epidemiology of lower extremity amputation in diabetic individuals

Metabolic Syndrome Resolution Post-hoc analysis of SURPASS trials demonstrated substantial reductions in metabolic syndrome prevalence: Significant improvements in multiple cardiovascular risk factors simultaneously Reductions in blood pressure, improved lipid profiles, and decreased waist circumference Resolution of metabolic syndrome criteria in a substantial proportion of participants Potential long-term cardiovascular benefits from comprehensive metabolic improvements Cardiovascular and Metabolic Comorbidities Heart Failure with Preserved Ejection Fraction (HFpEF) The SUMMIT phase 3 trial evaluated GLP2 in adults with HFpEF and obesity: Statistically significant reduction in heart failure outcomes (composite endpoint) Improvements in heart failure symptoms and physical limitations measured by Kansas City Cardiomyopathy Questionnaire Enhanced exercise capacity as measured by 6-Minute Walk Test Distance Reduction in high-sensitivity C-reactive protein (inflammation marker) These findings established GLP2 as the first incretin therapy to demonstrate benefits on heart failure outcomes in this population

PlexusDx providers recommend a combination of timing, nutrition, and lifestyle adjustments to support tolerance and medication adherence
Practical Implications for Patients For patients, these findings are more than academic
Patients can present as heterozygotes with only one gene encoding for an abnormal enzyme, or as a homozygote with both genes encoding for the defective enzyme