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The GLP-1 and metformin combination works because the two medicines act through completely different routes

A study found that long-term IGF-1 administration in aged animals increases neurogenesis, vascular density and utilization of glucose in parts of the brain involved in memory and learning [8]

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Since the purpose of starting pimobendan before CHF is to delay the onset of CHF, as many as 80% of these dogs will never need to be treated with this extremely expensive drug at all, much less for the rest of their lives