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Role of gut-liver axis Cirrhosis is associated with dramatic alterations of the gut microbiome [64], which likely contribute to CHE pathogenesis via disruption of the gut-liver-brain axis

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When considering adding a GLP-1 receptor agonist like Rybelsus, NICE guidance indicates these agents may be appropriate for people with type 2 diabetes who: Have a BMI of 35 kg/m or higher (adjusted for ethnicity) and specific psychological or medical problems associated with obesity, or Have a BMI lower than 35 kg/m and for whom insulin therapy would have significant occupational implications, or weight loss would benefit other significant obesity-related comorbidities GLP-1 therapy should only be continued if there is a beneficial metabolic response, defined as a reduction in HbA1c of at least 11 mmol/mol (1.0%) and weight loss of at least 3% of initial body weight at six months

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