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Pregnancy and breastfeeding: Avoid use without explicit clinician guidance due to limited safety data

If your CGM looks insulin-typical (40+ point spikes after rice, prolonged hyperglycemia after dinner), the case for metformin or a GLP-1 before spironolactone gets stronger

Moreover, inhibition of PCSK9 has been shown to significantly decrease cardiovascular outcomes in patients with type 2 diabetes and atherosclerotic disease [14]

These outcomes were accompanied by improvements in cardiometabolic risk factors, including reductions in systolic blood pressure (47 mmHg), improvements in lipid profiles (decreased triglycerides, increased HDL cholesterol), and enhanced insulin sensitivity markers

Protein intake also stimulates GLP-1 secretion, with studies suggesting that higher-protein meals elicit greater incretin responses compared to carbohydrate-predominant meals