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Echocardiography is also used to determine the left ventricular ejection fraction, an objective measure of the heart's pumping ability (31)

Diabetologia 51:22812289 Heart E, Cline GW, Collis LP, Pongratz RL, Gray JP, Smith PJ (2009) Role for malic enzyme, pyruvate carboxylation, and mitochondrial malate import in glucose-stimulated insulin secretion

These improvements in metabolic markers occur alongside reductions in body weight and fat mass, indicating comprehensive metabolic benefit rather than isolated effects