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This requirement of ECL1 recognition drives the above six key positions in dual or triple agonists (tirzepatide, peptide 20 (MAR423), and retatrutide) to use amino acids similar to those in GLP-1/GCG, while the other positions in the middle region show considerable variability (Fig

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However, when only placebo-controlled studies were analysed, the impact of metformin on endogenous glucose production (EGP) was not significant unless concomitant drug-induced reductions in plasma insulin were used to adjust EGP [13]

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