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The concern about hyperglycemia is mitigated by simultaneous GLP-1 receptor activation, which enhances insulin secretion and suppresses hepatic glucose production through different pathways

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John Eng noted a similarity between exendin-4 found in Gila venom to Glucagon-like peptide (GLP), and it was able to resist breakdown by DPP

In states of insulin resistance, impairments in phosphatidylinositol 3-kinase (PI3K) and mitogen-activated protein kinase (MAPK) signaling pathways can disturb the balance between nitric oxide (NO) production and endothelin-1 secretion, resulting in endothelial dysfunction [56,57,58] (refer to Fig