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In practice, this is unlikely to cause problems

The absence of direct comparisons in double-blind, randomized controlled trials, the medical research gold standard, makes it challenging to draw definitive conclusions

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Moreover, use of dulaglutide in people with T2DM is likely to confer additional renal benefits, and dulaglutide may be used in advanced chronic kidney disease at any eGFR level and without dose adjustment in contrast with most other noninsulin diabetes therapies (134, 135)

The wearing-off pattern is most pronounced during weeks one through four, before steady state is achieved