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If needed to achieve glycemic goals, use of anti-diabetic agents showing potential CV benefits (e.g., metformin, pioglitazone) or proven CV safety (e.g., DPP-4 inhibitors, lixisenatide, exenatide, insulin, glimepiride) with lower risks of hypoglycemia is recommended [49]

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The pulsatile GH secretion induced by Tesamorelin remains physiological (preservation of endogenous pulses), distinguishing this approach from exogenous recombinant GH administration producing supra-physiological non-pulsatile levels

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