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A randomized, double-blind, placebo controlled trial enrolled 2,539 adults with an average baseline body weight of 105 kg (231 pounds) and an average body mass index (BMI) of 38

After an oral glucose load or a meal, this DPP-4 inhibition resulted in a 2- to 3-fold increase in circulating levels of active GLP-1 and GIP, decreased glucagon concentrations, and increased responsiveness of insulin release to glucose, resulting in higher C-peptide and insulin concentrations

Starting doses on the lower end (300mcg) and progressing slowly makes sense

Research suggests the largest improvements often occur in individuals who: Have obesity Have hypertension before starting treatment Lose a substantial amount of weight Have insulin resistance Have metabolic syndrome Improve their nutrition and exercise habits People with higher baseline blood pressure readings generally experience greater reductions than those whose blood pressure is already within a healthy range