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For decades, we relied on the magic of glycemic control and control of hypertension to turn the tide of worsening DKD, only to see some patients with decent HbA1Cs still suffer from a decline of kidney function

This is literally the same mechanism that GLP-1 medications are activating just from the other direction

Once activated, the SMAD family member 4 (SMAD4) enters the nuclei and regulates the expression of genes inhibiting myoblast proliferation and differentiation, such as paired Box 3 (Pax3) and MyoD [120]

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IGF-1 can have all the side effect of GH or insulin use with an added negative: gastrointestinal (GI) growth