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Possible reasons include Type 1 diabetes diagnosis, advanced Type 2 diabetes with severely depleted beta cells, contraindication to GLP-1 drugs (thyroid cancer history, pancreatitis history), insurance or cost barriers, prior GLP-1 intolerance, or very high blood sugar requiring immediate insulin coverage

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In diabetes and obesity, growth factor-associated signaling in the brain deteriorates and energy use in the cerebral cortex decreases simultaneously with pro-inflammatory changes, while GLP-1RAs improve neuronal growth and repair, reduce inflammation and apoptosis, as well as oxidative stress [31]

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