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However, in the AWARD 7 trial, a dedicated 52-week trial of dulaglutide in patients with diabetic kidney disease, stage 3-4, the decline with time was significantly reduced compared with insulin glargine [29]

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Subtle conformational dynamics allow the C-terminus of GLP-1 to access the ECD binding site, and the ligand binding triggers further dissociation of the ECD from the TMD allowing the N-terminus of GLP-1 to enter the orthosteric pocket in the TMD and activate the receptor