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A number of data accumulated, demonstrating an association between cytotoxic T cell antigen-4 (CTLA-4), which is a major negative regulator of T-cell mediated immune functions, and autoimmune diseases including Hashimoto's thyroiditis

Endocrinologists viewed their ideal patient as an individual with established cardiovascular disease or high cardiovascular risk, including those with diabetic kidney disease, who are already being treated with more than one oral medication (including either SGLT2is or GLP1-RAs) and an HbA1c level exceeding the established target

Hence, it leads to skin whitening, even skin tone, and reduced dark spots

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