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Patient-specific factors that influence choice include: Concurrent diabetes : Patients with type 2 diabetes may have broader access through NHS prescribing pathways BMI and weight loss goals : Higher BMI patients may benefit from agents with greater weight loss efficacy Tolerability : Previous experience with gastrointestinal side effects may guide selection Injection preference : Some patients strongly prefer weekly over daily injections, or oral over injectable formulations Cardiovascular disease : Certain GLP-1 agonists have proven cardiovascular benefits, which may be relevant for high-risk patients Ultimately, the choice should be individualised through shared decision-making between patient and clinician, considering the available evidence, licensed indications, local prescribing policies, and patient preferences
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Nevertheless, relative glutamatergic excess appears to be specific to early stages of illness [8], and relates to more severe symptoms at presentation [17], as well as gray matter decline [19], cognitive [20], and functional [16, 17] impairments
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