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Two reactions involving glucose metabolites catalyse the reduction of NADP+ to NADPH: glucose 6-phosphate dehydrogenase, forming 6-phosphogluconate, and phosphogluconate dehydrogenase, which yields the 5-carbon sugar ribulose 5-phosphate, liberating carbon dioxide from carbon-1 of the substrate

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PIONEER 3: Head-to-head vs Januvia (sitagliptin) 1,4 Study design: 78-week, randomized, double-blind, double-dummy, active controlled, parallel-group, phase 3a trial designed to assess the efficacy and assess long-term adverse event profile of once-daily semaglutide tablets vs Januvia in addition to metformin with or without sulfonylurea

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This limited metabolism explains its minimal impact on blood glucose and insulin levels