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Among the nine parallel RCTs, five studies (21, 44, 45, 48, 49) demonstrated low risk of bias across all domains, while the remaining four exhibited some concerns or high risk in specific domains (particularly randomization process and deviations from intended interventions)

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Secondly, GLP-1 receptor agonists carry important safety considerations including risk of pancreatitis, gallbladder disease, and potential thyroid C-cell tumours (based on rodent studies, though human relevance remains uncertain)

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