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However, as maximal GLP-1-stimulated cAMP increases occur in the nanomolar concentration, research has elucidated alternative signaling pathways involved in GLP-1-mediated insulin secretion, particularly that of the protein kinase C (PKC) [74]

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Third, differences might be explained by adherence rates and monitoring, as the stricter monitoring and controlled environments in RCTs - which enhance medication efficacy and patient compliance - are generally not replicable in real-world settings.The high variability in adherence and patient management in real-world scenarios likely dilutes the potential maximum efficacy seen under controlled trial conditions