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The rate of dropout in studies of oral semaglutide has been significant, approximately 25% in recent trials, reflecting tolerability concerns, mainly due to nausea (source)

549 Impaired oxidation of NADH, a function of respiratory complex I, increases NADH levels, driving the equilibrium toward lactate accumulation, which differs from the proportional increase in lactate and pyruvate seen in pyruvate dehydrogenase deficiency