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TNF-, a central mediator of the inflammatory cascade, exacerbates renal damage by promoting podocyte apoptosis, recruiting M1 macrophages, and activating the NF-B pathway, which amplifies downstream cytokine production

GLP-1 receptor agonists like semaglutide are peptides that influence appetite, blood sugar, and metabolism

136,169,170 With the accumulation of more clinical data and the development of new drugs, these treatment options are expected to provide more effective and comprehensive treatment choices for diabetes patients

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The FDAs stated concerns are: (1) theoretical risk of allergic reactions with repeated peptide administration, (2) quality control concerns about compounding purity and consistency, and (3) no Phase 1-3 trials conducted under FDA oversight

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