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It is a progressive condition

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Autonomic nervous system activity changes, particularly alterations in sympathetic and parasympathetic tone, can modulate intestinal blood flow, mucus secretion, and immune cell function, indirectly influencing the microbial ecosystem ( 2.1.3 Key signaling pathways Signal transmission within the MGBA involves multiple key pathways, including neural, immune, endocrine, and metabolic pathways, which interact to form a complex regulatory network

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Many patients complete the initial 12-week program and then transition to a maintenance phase

However, these medications are available in combination with metformin or other antihyperglycemic agents, which may provide the advantage of decreased pill burden for patients with uncontrolled diabetes