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DOI: 10.1016/j.clnu.2017.04.002, Takakura, K., Koda, N., Kinoshita, Y., et al

Studies have consistently shown that cortisol exposure leads to islet cell dysfunction and significant decrease in GLP-1 production[3], which is counterproductive and renders the clinical use of GLP-1 agonists such as semaglutide and tirzepatide (GLP-1/GIP) nearly ineffective

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For beginners, the takeaway is that "GHRH analog vs ghrelin mimetic" is the real dividing line, and the peptide names simply sit on one side or the other

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All three receptor pathways are maximally activated