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This concept eventually led to drugs like sitagliptin (approved 2006), but those would generally have less potent effects than direct GLP-1 agonists since GLP-1 levels only double or triple on DPP-4 inhibitors (and those drugs rely on some residual pancreatic function and meal stimulation) ( [59] )

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thus, glomerular pressure increases and leads to glomerular hyperfiltration until organ damage develops [84]