Human trials remain limited, so much of the discussion comes from preclinical research, clinician experience, and user reports
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A 2021 analysis of three-year follow-up data from the EDICT (Efficacy and Durability of Initial Combination Therapy) randomized controlled trial found that initiation of triple therapy with metformin, pioglitazone, and exenatide at the time of diagnosis not only led to greater improvements in HbA1C values at six months, it also significantly reduced HbA1C levels by 0.5% more than sequential initiation of metformin followed by glipizide and insulin in diabetics with a HbA1C value of approximately 9% (Abdul-Ghani 2021)
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Thus, the spectrum of additional functional activities reported for C domains in non-ribosomal multi enzyme complexes is still growing and may significantly contribute to the diversification of naturally synthetized peptide products
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