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These findings led to changes in clinical practice guidelines modern diabetes guidelines recommend GLP-1 agonists (or related drugs) for patients with type 2 diabetes who have cardiovascular risk, and even suggest using a GLP-1 RA prior to insulin in many cases due to their multiple benefits and weight loss advantage ( [10] ) ( [11] )
Serious but less common risks include pancreatitis, gallbladder problems, and, for tirzepatide , a boxed warning about thyroid tumors observed in animal studies
The glutamate residue is linked through its side-chain carboxyl, giving a gamma-glutamyl bond rather than a standard alpha-peptide bond, which is why the molecule resists most intracellular peptidases and is cleaved chiefly by gamma-glutamyl transpeptidase at the cell surface
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