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Thank you experts for the great discussion so far! The discussion brought to mind this observation (correct me if I'm wrong!): the drugs that have show good CV benefits are also the ones that are associated with weight loss, e.g. SGLT2 inhibitors and GLP-1 agonist (and the curious reason why the DPP-4 inhibitors don't seem to have as much CV benefit despite being in a common pathway). How much of the benefit from these drugs can be explained by weight loss alone (i.e. if someone can lose that much weight with lifestyle changes, how much do they gain comparatively)?

As a secondary question, we are taught to think of type 2 diabetes as a disease of glucose control dysregulation. Do you foresee a future shift in the paradigm and our approach to its management? For example, hyperglycemia may just be a manifestation of a broader metabolic derangement and how the body interacts with nutrient intake and energy expenditure. Perhaps longterm follow up data from the bariatrics surgery literature will point to a future where aggressive weight loss becomes first line focus for diabetes (meaning, we prescribe weight loss medications whose principle mechanisms are not to reduce blood glucose level)?