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Because you're excreting sugar, you're also excreting calories, which is why some modest weight loss is often a side effect

The beneficial effects of GLP-1 RAs on HRQoL and other outcomes in HFpEF are likely due to pleiotropic impacts, related or not to weight reduction, such as decongestion (mainly due to the reduction of increased plasma volume associated with obesity and epicardial constrain), reverse cardiac remodelling (mainly due to the decrease in epicardial fat and regression of left atrial and LV myopathy, lowering intracardiac pressure) and anti-inflammatory actions, among others

A 2005 study demonstrated that both peptide and non-peptide GH secretagogues act through the GHS-R1a receptor but can also function as ghrelin receptor ligands with distinct binding properties, suggesting potential differences in downstream signaling despite shared receptor engagement