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[13] In the first step of the reaction, acyl-CoA synthetase catalyzes the transfer of adenosine monophosphate group (AMP) from an ATP molecule onto the fatty acid generating a fatty acyladenylate intermediate and a pyrophosphate group (PP i )

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However, studies indicate that transitioning from intensive insulin therapy to combination therapy significantly improves treatment-related quality of life [55]

NICE advises continuing treatment only if there is a clinically meaningful HbA1c reduction (for example 11 mmol/mol [1%]) and weight loss of at least 3% of initial body weight