Based on published data: Tirzepatide: Highest average HbA1c reduction in trials Semaglutide: Strong glucose control + proven cardiovascular benefit Dulaglutide & Liraglutide: Reliable, well-studied options Oral semaglutide: Effective non-injectable alternative But 'best' depends on: Baseline HbA1c, Cardiovascular risk, Weight goals, Tolerability, Convenience, and Physician guidance
It aggravates various cardiovascular (CV) risk factors and is, per se, an independent risk factor for CV mortality
Thus, the role of creatinine adjustment for urinary biomarkers is uncertain 40
Nevertheless, the involvement of an hypomethylation cannot be ruled out, because in vitro studies suggest that a low concentration of homocysteine specifically inhibits endothelial cell regeneration and directly activates quiescent vascular smooth muscle cells through a mechanism involving decreased carboxymethylation of p21 ras (Lee and Wang, 1999