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Unlike insulin therapy, dulaglutide works by enhancing the natural hormonal response to meals, lowering blood sugar through multiple mechanisms

doi: 10.4239/wjd.v7.i17.354 [DOI] [PMC free article] [PubMed] [Google Scholar] 72

NLRP6 deficiency also disrupts goblet cell mucus secretion and the production of epithelial IL-18 and AMPs, impairing bacterial control (219, 220), and leading to AMPs imbalance, dysbiosis, and autoimmunity

If the patient is receiving metformin, DPP-4 inhibitors (DPP-4i), GLP-1 receptor agonists GLP-1 RAs), and/or SGLT-2 inhibitors (SGLT-2i), these should be continued, and the discontinuation of pioglitazone should be considered