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Fasting insulin values were available in 28 participants, with insulin resistance, defined as high homeostatic model assessment for insulin resistance (HOMA-IR) 1.9 [15], being reported in 24 out of 28 cases (86%), while severe insulin resistance, defined as HOMA-IR exceeding 4, being recorded in 15 out of 28 participants (53.5%)

Poor glycaemic control caused by insulin induced lipohypertrophy

In murine models, changes in microbiota initiated by SGLT-2is were connected to diminished renal fibrosis and decreased generation of pro-inflammatory cytokines

[3] [4] 5 kg of weight loss per week, though individual responses vary considerably depending on age, sex, hormonal status, and metabolic health