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Pharmaceutical companies quickly pushed back

While these studies do not directly target the knee joint, they substantiate the core principles required for intra-articular therapy: 1) precise delivery of energy to a defined deep target, 2) the ability to trigger relevant biological responses (anti-inflammatory or neuromodulatory), and 3) a viable clinical safety profile

| doi:10.1038/s41598-019-45906-5 Ghonimy A, Zhang DM, Farouk MH, Wang Q.: The Impact of Carnitine on Dietary Fiber and Gut Bacteria Metabolism and Their Mutual Interaction in Monogastrics

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They have shown a further reduction of HbA1c percentage between 0.5 and 0.7 in this combination and in some studies a lower rate of hypoglycaemic events was observed (12, 18, 21, 31)