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An increased activity of the hypothalamic-pituitary adrenal axis has been observed in patients with type 2 diabetes mellitus with asymptomatic autonomic imbalance with prevalent parasympathetic failure (20)

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These include short-acting agents (e.g., exenatide BID), long-acting formulations (e.g., liraglutide, semaglutide, dulaglutide), dual agonists such as tirzepatide (GIP/GLP-1 RA), and novel oral agents like orforglipron and danuglipron

The addition of IGF-1 inhibits IL-1-induced matrix degradation [28]