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Some hypothetical explanations for the weaker anti-obesity response for both GLP-1 RAs in people with diabetes include the background medications that promote weight gain, the fear of hypoglycaemia inherently related to the treatment of diabetes, a decrease in glycosuria and subsequently less weight loss in diabetics, an altered microbiota in patients with obesity and diabetes and a genetic background that predispose to weight gain in patients with diabetes
In fact, the Mediterranean diet, which includes a lot of nuts has been recommended for the prevention of cardiovascular disease as per American College of Cardiology/American Heart Association (ACC/AHA) guidelines
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