Additionally, patients within this HbA1c range may have been undergoing more aggressive diabetes management strategies, such as insulin adjustments or the use of GLP-1 agonists, which are known to cause gastrointestinal side effects like nausea and delayed gastric emptying.Conversely, the "More than 9" HbA1c category, representing those with the poorest glycemic control, shows a lower frequency of severe symptoms. This evidence concerns the gene INS and diabetes mellitus.