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It also reduced a secondary kidney composite outcome (sustained 50% eGFR decline, ESKD, or renal death) by 44%

This triple mechanism produces greater weight loss, potentially better metabolic improvements, and additional effects like increased energy expenditure from glucagon activation

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The only benefit may be the possibility of pyruvate decarboxylation by the pyruvate dehydrogenase complex (PDC) [96], which produces the equimolar amount of NADH

That shift can support gradual weight loss without relying only on willpower