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This layered, evidencebased approach offers the best chance of longterm control and visible improvement

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Long-term treatment of acromegaly with pegvisomant, a growth hormone receptor antagonist

In the triple therapy cohort receiving metformin, SGLT2-i, and GLP-1RA, overbasalization declined from 62.5 to 17.5%, and 42.5% of patients were able to stop insulin entirely, reinforcing the additive benefits of combination therapy [44]