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The good news is that early research is encouraging

It is thought that the loss of incretin effect is from (1) a reduction in secretion of incretin hormone in response to nutrients (hyposecretion) and/or (2) a reduction in insulinotropic effect on pancreatic beta cells (insulin resistance)

This is evidenced by up-regulation of glycolytic enzyme expression, increased rates of glucose uptake and consumption, as well as augmented ATP content, insulin secretion and glycolytic flux after removal of Exendin-4

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