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GLP-1RA or dual GIP/GLP-1RA added to basal insulin compared to basal insulin titrated with a rigorous intention-to-treat approach is moderately effective in preventing further increase in daily basal insulin dose from achieving treat-to-target glycemic goals ( daily insulin dose, SMD -0.49, 95% CI -0.71

Glycemic control with diet, sulfonylurea, metformin or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49)

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Importantly, IGF-1 activity is influenced not only by total growth hormone levels but by the timing and amplitude of growth hormone pulses