The intensive treatment of the multiple risk factors reduces the development/progression of renal disease18 which is why guidelines insist on comprehensive management of the patient with diabetes (glycemic control and control of cardiovascular risk factors, use of renin-angiotensin system inhibitors, as well as lifestyle changes, including smoking cessation or weight loss in overweight/obese individuals, among others).19 However, the residual renal risk remains very high in optimally treated patients.20 More recently, iSGLT2 has been shown to reduce the risk of cardiovascular and renal events, but still, the residual risk of renal disease progression remains high.21,22 Nevertheless, although the rate of diabetes-related complications (such as myocardial infarction, stroke, lower limb amputations or mortality) have decreased significantly in recent decades, this is not the same for CKD patients requiring renal replacement therapy attributed to diabetic kidney disease (DKD).23 Therefore new treatments are needed that improve glycemic control independently of GFR, with a low risk of hypoglycemia and able to reduce cardiovascular and renal risk in this population
Incretin hypersecretion in post-gastric bypass hypoglycemia primary problem or red herring
34 EndicottS
What We Dont Yet Know Responsible disclosure requires acknowledging gaps in knowledge: Long-term effects of continuous use over months or years in humans Potential interactions with medications or other supplements Effects in specific populations (pregnant women, children, elderly, people with certain medical conditions) Optimal dosing protocols for different applications Comparative effectiveness of different administration routes Anyone considering BPC 157 should approach it as an experimental compound, ideally under guidance from a knowledgeable practitioner, and should monitor their response carefully
