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Intermuscular adipose tissue-derived inflammatory adipokines, exacerbated by aging, obesity, and sedentary behavior, promote both fat accumulation and chronic inflammation within skeletal muscle, driving adipogenic differentiation at the expense of myogenesis and thereby contributing to reduced muscle quality and increased metabolic risk [81]

Second, kidney injury in diabetes appears to be related to glomerular hyperfiltration [93, 94], which is likely related to an excessive reabsorption of sodium in the proximal tubule, leading diminished delivery of sodium to the macula densa, and (via tubuloglomerular feedback) to afferent arteriolar dilatation [95, 96]

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GLP-1 agonists at starting doses may produce mild nausea as the body acclimates