Effects of short-term inactivity on glucose tolerance, energy expenditure, and blood flow in trained subjects

1998 ◽  
Vol 84 (4) ◽  
pp. 1365-1373 ◽  
Author(s):  
Paul J. Arciero ◽  
Denise L. Smith ◽  
Jorge Calles-Escandon
Keyword(s):  
Blood Flow ◽  
Energy Expenditure ◽  
Glucose Tolerance ◽  
Resting Metabolic Rate ◽  
Tolerance Test ◽  
Endurance Athletes ◽  
Oral Glucose ◽  
Relative Contribution ◽  
Short Period ◽  
Glucose Ingestion

The purpose of this investigation was to examine the effects of 7–10 days of inactivity (IA) on glucose tolerance (GT), resting metabolic rate (RMR), thermic effect of a meal (TEM), and limb blood flow in endurance-trained men. Eight highly trained (peak O2 consumption 64 ± 2 ml ⋅ kg−1 ⋅ min−1) endurance athletes participated in this study involving two identical test days, one ∼24 h after a normal training bout (Tr) and the second after 7–10 days of IA. The following tests were conducted at each visit: 75-g oral glucose tolerance test (OGTT), RMR, and TEM and measurements of calf and forearm blood flow (BF) by using venous occlusive plethysmography. Body weight remained unchanged during this short period of IA (Tr, 78.5 ± 1 kg; IA, 78.7 ± 1 kg). The area under the glucose and insulin curves increased 65% (Tr, 3,375 ± 877 vs. IA, 5,559.4 ± 621 mg ⋅ dl−1 ⋅ 180 min−1) and 73% (Tr, 2,182.5 ± 270 vs. IA, 3,793.1 ± 739 μU ⋅ ml−1 ⋅ 180 min−1) after IA, respectively ( P < 0.01). RMR decreased significantly (4%; 1.5 ± 0.02 vs. 1.44 ± 0.02 kcal/min; P < 0.05) and respiratory exchange ratio during the OGTT increased (4%, 0.812 ± 0.011 vs. 0.842 ± 0.009; P < 0.05) after IA, whereas TEM increased similarly in the Tr and IA states. In the Tr state, mean calf BF increased by 22% (3.17 ± 0.22 vs. 3.87 ± 0.38 ml ⋅ 100 ml−1 ⋅ min−1; P < 0.05) during the OGTT but remained unchanged after IA, whereas no differences at rest or during OGTTs existed between the two conditions for forearm BF. Incremental insulin area above fasting during the OGTT was correlated with mean calf BF in the Tr ( r = 0.76, P < 0.05) and IA ( r = 0.72, P < 0.05) states. In conclusion, 7–10 days of IA results in a deterioration in GT and a reduction in RMR. After glucose ingestion, calf BF was elevated compared with resting levels in the Tr state but was unchanged in the IA state; however, limb BF was not related to GT or RMR. Thus our findings raise questions regarding the relative contribution of BF in modulating glucose tolerance and energy expenditure in endurance athletes in their habitual Tr or IA state.

Impaired superficial femoral artery vasodilation and leg blood flow in young obese women following an oral glucose tolerance test

2012 ◽  
Vol 37 (1) ◽  
pp. 176-183 ◽  
Author(s):  
T.D. Olver ◽  
T.J. Hazell ◽  
C.D. Hamilton ◽  
J.K. Shoemaker ◽  
P.W.R. Lemon
Keyword(s):  
Blood Flow ◽  
Glucose Tolerance ◽  
Young Women ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Obese Women ◽  
Leg Blood Flow ◽  
Glucose Ingestion

This study was designed to test the hypothesis that glucose ingestion following an overnight fast increases leg vascular conductance (LVCd) and superficial femoral artery (SFA) vasodilation in lean but not obese young women. Obese (23.5 ± 4.0 years, 84.7 ± 14.7 kg, 37.2% ± 6.4% fat; mean ± SD, n = 8) and lean (23.8 ± 2.4 years, 60.6 ± 4.0 kg, 22.3% ± 2.8% fat; n = 8) women arrived in the laboratory at 0830 h after a 12-h overnight fast for body composition (densitometry) assessment. Then, capillary blood glucose (BGlu), plasma insulin, heart rate, cardiac output, mean arterial pressure, leg blood flow (Doppler ultrasound), and LVCd were measured (after 15 min in the supine position), and at 30-min intervals for 2 h following glucose ingestion (75 g glucose load, 12.5% solution). Fasting BGlu concentration was not different between groups (obese = 5.1 ± 0.47 vs. lean = 4.9 ± 0.37 mmol·L–1, p = 0.71) but 60, 90, and 120 min postingestion BGlu was elevated (p ≤ 0.03) in the obese women. Insulin differences were not significant. Fasting LVCd was not different between groups (lean = 0.72 ± 0.49 vs. obese = 0.70 ± 0.19 mL·min–1·mm Hg–1; p = 0.48); however, LVCd, as well as Δ in SFA diameter were significantly elevated (p ≤ 0.04) in the lean compared with the obese group at 60, 90, and 120 min postglucose ingestion (LVCd, peak lean = 1.4 ± 0.5 vs. peak obese = 0.8 ± 0.1 mL·min–1·mm Hg–1; Δ in SFA, peak lean = 0.51 ± 0.30 vs. peak obese = 0.09 ± 0.45 mm). The reduced LVCd following glucose ingestion could contribute to impaired glucose tolerance. Further, the lack of SFA dilation may be evidence of impaired vascular insulin responsiveness in these obese young women.

scholarly journals Direct Measurements of the Permeability Surface Area for Insulin and Glucose in Human Skeletal Muscle

2003 ◽  
Vol 88 (10) ◽  
pp. 4559-4564 ◽  
Author(s):  
Soffia Gudbjörnsdóttir ◽  
Mikaela Sjöstrand ◽  
Lena Strindberg ◽  
John Wahren ◽  
Peter Lönnroth
Keyword(s):  
Skeletal Muscle ◽  
Blood Flow ◽  
Glucose Tolerance ◽  
Plasma Insulin ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Permeability Surface ◽  
One Step

Abstract To elucidate mechanisms regulating capillary transport of insulin and glucose, we directly calculated the permeability surface (PS) area product for glucose and insulin in muscle. Intramuscular microdialysis in combination with the forearm model and blood flow measurements was performed in healthy males, studied during an oral glucose tolerance test or during a one-step or two-step euglycemic hyperinsulinemic clamp. PS for glucose increased significantly from 0.29 ± 0.1 to 0.64 ± 0.2 ml/min·100 g after oral glucose tolerance test, and glucose uptake increased from 1.2 ± 0.4 to 2.6 ± 0.6 μmol/min·100 g (P &lt; 0.05). During one-step hyperinsulinemic clamp (plasma insulin, 1.962 pmol/liter), PS for glucose increased from 0.2 ± 0.1 to 2.3 ± 0.9 ml/min·100 g (P &lt; 0.05), and glucose uptake increased from 0.6 ± 0.2 to 5.0 ± 1.4 μmol/min·100 g (P &lt; 0.05). During the two-step clamp (plasma insulin, 1380 ± 408 and 3846 ± 348 pmol/liter), the arterial-interstitial difference and PS for insulin were constant. The PS for glucose tended to increase (P = not significant), whereas skeletal muscle blood flow increased from 4.4 ± 0.7 to 6.2 ± 0.8 ml/min·100 ml (P &lt; 0.05). The present data show that PS for glucose is markedly increased by oral glucose, whereas a further vasodilation exerted by high insulin concentrations may not be physiologically relevant for capillary delivery of either glucose or insulin in resting muscle.

scholarly journals Fructose Consumption Contributes to Hyperinsulinemia in Adolescents With Obesity Through a GLP-1–Mediated Mechanism

2019 ◽  
Vol 104 (8) ◽  
pp. 3481-3490 ◽  
Author(s):  
Alfonso Galderisi ◽  
Cosimo Giannini ◽  
Michelle Van Name ◽  
Sonia Caprio
Keyword(s):  
Glucose Tolerance ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Cell Function ◽  
Insulin Response ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Double Blind ◽  
Obesity And Diabetes ◽  
Glucose Ingestion

Abstract Context The consumption of high-fructose beverages is associated with a higher risk for obesity and diabetes. Fructose can stimulate glucagon-like peptide 1 (GLP-1) secretion in lean adults, in the absence of any anorexic effect. Objective We hypothesized that the ingestion of glucose and fructose may differentially stimulate GLP-1 and insulin response in lean adolescents and adolescents with obesity. Design We studied 14 lean adolescents [four females; 15.9 ± 1.6 years of age; body mass index (BMI), 21.8 ± 2.2 kg/m2] and 23 adolescents with obesity (five females; 15.1 ± 1.6 years of age; BMI, 34.5 ± 4.6 kg/m2). Participants underwent a baseline oral glucose tolerance test to determine their glucose tolerance and estimate insulin sensitivity and β-cell function [oral disposition index (oDIcpep)]. Eligible subjects received, in a double-blind, crossover design, 75 g of glucose or fructose. Plasma was obtained every 10 minutes for 60 minutes for the measures of glucose, insulin, and GLP-1 (radioimmunoassay) and glucose-dependent insulinotropic polypeptide (GIP; ELISA). Incremental glucose and hormone levels were compared between lean individuals and those with obesity by a linear mixed model. The relationship between GLP-1 increment and oDIcpep was evaluated by regression analysis. Results Following the fructose challenge, plasma glucose excursions were similar in both groups, yet the adolescents with obesity exhibited a greater insulin (P &lt; 0.001) and GLP-1 (P &lt; 0.001) increase than did their lean peers. Changes in GIP were similar in both groups. After glucose ingestion, the GLP-1 response (P &lt; 0.001) was higher in the lean group. The GLP-1 increment during 60 minutes from fructose drink was correlated with a lower oDIcpep (r2 = 0.22, P = 0.009). Conclusion Fructose, but not glucose, ingestion elicits a higher GLP-1 and insulin response in adolescents with obesity than in lean adolescents. Fructose consumption may contribute to the hyperinsulinemic phenotype of adolescent obesity through a GLP-1–mediated mechanism.

scholarly journals The influence of mildronate on peripheral neuropathy and some characteristics of glucose and lipid metabolism in rat streptozotocin-induced diabetes mellitus model

2011 ◽  
Vol 57 (5) ◽  
pp. 490-500 ◽  
Author(s):  
J. Sokolovska ◽  
J. Rumaks ◽  
N. Karajeva ◽  
D. Grinvalde ◽  
J. Sharipova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Neuropathic Pain ◽  
Blood Glucose ◽  
Glucose Tolerance ◽  
Tolerance Test ◽  
Diabetic Rat ◽  
Oral Glucose ◽  
Glucose And Lipid Metabolism ◽  
Glucose Ingestion ◽  
Streptozotocin Induced Diabetes

Streptozotocin (STZ) was used to induce the diabetic rat model. STZ rats were treated with mildronate (100 mg/kg daily, per os or intraperitoneally for 6 weeks). Body weight, blood glucose, triglyceride, ketone body concentrations, glycated hemoglobin percent (HbA1c%), glucose tolerance, and the development of neuropathic pain were monitored throughout the experiment. In the STZ + mildronate group, mildronate treatment caused a significant decrease in mean blood glucose (on week 4) and triglyceride concentrations (on weeks 3-6), significantly slowed the increase in HbA1c% (on week 6) and improved glucose tolerance 120 minutes after glucose ingestion during oral glucose tolerance test versus the STZ group. Mildronate completely protected development of STZ-induced neuropathic pain from the first administration week up to end of the experiment. The obtained data indicate clinical usefulness of the drug for the treatment of diabetes mellitus and its complications.

scholarly journals Non-esterified fatty acid levels and physical inactivity: the relative importance of low habitual energy expenditure and cardio-respiratory fitness

2002 ◽  
Vol 88 (3) ◽  
pp. 307-313 ◽  
Author(s):  
Paul W. Franks ◽  
Man-Yu Wong ◽  
Jian'an Luan ◽  
Jo Mitchell ◽  
Susie Hennings ◽  
...  
Keyword(s):  
Physical Activity ◽  
Energy Expenditure ◽  
Glucose Tolerance ◽  
Oral Glucose Tolerance Test ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Activity Level ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Cardio Respiratory Fitness

The fasting concentration of non-esterified fatty acids (NEFA) and the degree to which it declines during an oral glucose tolerance test are closely associated with insulin resistance and glucose intolerance. However, relatively few studies have described possible environmental determinants of NEFA concentrations. Physical activity is likely to be related to NEFA levels, but habitual activity level is difficult to quantify in epidemiological studies. In particular, it is unclear whether NEFA is more closely related to cardio-respiratory fitness or to habitual energy expenditure. In order to quantify these relationships, we analysed data from the Ely prospective population-based study in which 931 subjects underwent a glucose tolerance test with measurements of cardio-respiratory fitness and 4 d energy expenditure by heart-rate monitoring, a technique previously validated against whole-body calorimetry and doubly-labelled water. In order to estimate the latent variables of usual fitness and energy expenditure, a subset of 190 subjects underwent repeat testing on three further occasions over 1 year. In analyses adjusting only for age and sex, energy expenditure and cardio-respiratory fitness were both negatively correlated with the total area under the NEFA curve following the oral glucose load (standardised β coefficients -0·030 and -0·039 respectively; both P<0·001) However, further adjustment for degree of obesity and bivariate measurement error suggested that the effect of energy expenditure was significantly greater than that for fitness (-0·047 and -0·005 respectively). These results suggest that the area under the NEFA curve in the oral glucose tolerance test, a measure of insulin sensitivity, is strongly associated with the habitual level of physical activity.

scholarly journals Fetuin-A Characteristics during and after Pregnancy: Result from a Case Control Pilot Study

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Serdar Farhan ◽  
Ammon Handisurya ◽  
Jelena Todoric ◽  
Andrea Tura ◽  
Giovanni Pacini ◽  
...  
Keyword(s):  
Glucose Tolerance ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Fetuin A ◽  
Early Postpartum ◽  
Glucose Ingestion ◽  
Peptide Secretion ◽  
Pregnancy Result

Objective. Fetuin-A has been associated with gestational diabetes mellitus (GDM). We investigated fetuin-A levels during and after pregnancy in women with GDM. Fetuin-A measurements were performed in 10 women with GDM and 10 age and body mass index (BMI) matched healthy pregnant women. All women underwent an oral glucose tolerance test (OGTT) in and 3 months after gestation.Results. Fasting fetuin-A correlated with BMI in women with former GDM (r=0.90,P<0.0001) but showed no association with parameters of glucose tolerance in women with GDM or post-GDM. GDM featured significantly lower insulin sensitivity and higher insulin and C-peptide secretion profiles compared to NGT during pregnancy (P<0.05). Fasting and postprandial fetuin-A did not differ between groups, neither during nor after pregnancy.Conclusion. Fetuin-A is not influenced by glucose tolerance during or after pregnancy or acute glucose elevations following glucose ingestion in young women, but closely relates to BMI early postpartum.

scholarly journals Thermogenic Effect of Glucose in Hypothyroid Subjects

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Agnieszka Kozacz ◽  
Paulina Grunt ◽  
Marta Steczkowska ◽  
Tomasz Mikulski ◽  
Jan Dąbrowski ◽  
...  
Keyword(s):  
Glucose Tolerance ◽  
Tolerance Test ◽  
Control Group ◽  
Oral Glucose ◽  
Mean Values ◽  
Adrenergic Response ◽  
Glucose Ingestion ◽  
Glucose Plasma ◽  
Effect Of Glucose ◽  
Hypothyroid Patients

The importance of thyroid hormone, catecholamines, and insulin in modification of the thermogenic effect of glucose (TEG) was examined in 34 healthy and 32 hypothyroid subjects. We calculated the energy expenditure at rest and during oral glucose tolerance test. Blood samples for determinations of glucose, plasma insulin, adrenaline (A), and noradrenaline (NA) were collected. It was found that TEG was lower in hypothyroid than in control group (19.68±3.90versus55.40±7.32 kJ, resp.,P<0.0004). Mean values of glucose and insulin areas under the curve were higher in women with hypothyroidism than in control group (286.79±23.65versus188.41±15.84 mmol/L·min,P<0.003and7563.27±863.65versus4987.72±583.88 mU/L·min,P<0.03resp.). Maximal levels of catecholamines after glucose ingestion were higher in hypothyroid patients than in control subjects (Amax—0.69±0.08versus0.30±0.07 nmol/L,P<0.0001, and NAmax—6.42±0.86versus2.54±0.30 nmol/L,P<0.0002). It can be concluded that in hypothyroidism TEG and glucose tolerance are decreased while the adrenergic response to glucose administration is enhanced. Presumably, these changes are related to decreased insulin sensitivity and responsiveness to catecholamine action.

scholarly journals The Leu7Pro Polymorphism of PreproNPY Is Associated with Decreased Insulin Secretion, Delayed Ghrelin Suppression, and Increased Cardiovascular Responsiveness to Norepinephrine during Oral Glucose Tolerance Test

2005 ◽  
Vol 90 (6) ◽  
pp. 3646-3652 ◽  
Author(s):  
Ulriikka Jaakkola ◽  
Tom Kuusela ◽  
Tuomas Jartti ◽  
Ullamari Pesonen ◽  
Markku Koulu ◽  
...  
Keyword(s):  
Insulin Secretion ◽  
Glucose Tolerance ◽  
Oral Glucose Tolerance Test ◽  
Baroreflex Sensitivity ◽  
Glucose Tolerance Test ◽  
Hormone Secretion ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Glucose Ingestion

Context: Neuropeptide Y (NPY) plays a role in angiogenesis, cardiovascular regulation, and hormone secretion. The leucine7 to proline7 (Leu7Pro) polymorphism of preproNPY is associated with vascular diseases and has an impact on hormone levels in healthy subjects. Objective: The current study investigated the role of the Leu7Pro polymorphism in metabolic and cardiovascular autonomic regulation. Design and Subjects: A 5-h oral glucose tolerance test was performed on 27 healthy volunteers representing two preproNPY genotypes (Leu7/Pro7 and Leu7/Leu7) matched for age, sex, body mass index and physical activity. Main Outcome Measures: Simultaneously we performed cardiovascular autonomic function tests and plasma measurements of sympathetic transmitters, glucose, insulin, and ghrelin. Results: The subjects with Leu7/Pro7 genotype had decreased plasma NPY, norepinephrine (NE), and insulin concentrations and insulin to glucose ratios. The suppression of ghrelin concentrations after glucose ingestion was delayed in these subjects. They also had increased heart rate variability indices and baroreflex sensitivity. However, they displayed significant negative association of NE concentration with variability of low-frequency R-R-intervals and with baroreflex sensitivity. Conclusions: The Leu7Pro polymorphism of preproNPY is related to decreased level of basal sympathetic activity, decreased insulin secretion, and delayed ghrelin suppression during oral glucose tolerance test. The increased responsiveness of autonomic functions to NE associated with the polymorphism may be connected to increased cardiovascular vulnerability.

Changes of the plasma metabolome during an oral glucose tolerance test: is there more than glucose to look at?

2009 ◽  
Vol 296 (2) ◽  
pp. E384-E393 ◽  
Author(s):  
Xinjie Zhao ◽  
Andreas Peter ◽  
Jens Fritsche ◽  
Michaela Elcnerova ◽  
Andreas Fritsche ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Glucose Tolerance ◽  
Oral Glucose Tolerance Test ◽  
Bile Acids ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Metabolic Pattern ◽  
Glucose Ingestion

The oral glucose tolerance test (oGTT) is a common tool to provoke a metabolic challenge for scientific purposes, as well as for diagnostic reasons, to monitor the kinetics of glucose and insulin. Here, we aimed to follow the variety of physiological changes of the whole metabolic pattern in plasma during an oGTT in healthy subjects in a nontargeted reversed-phase ultra performance liquid chromatography coupled to electrospray ionization quadrupole time of flight mass spectrometric metabolomics approach. We detected 11,500 metabolite ion masses/individual. Applying multivariate data analysis, four major groups of metabolites have been detected as the most discriminating oGTT biomarkers: free fatty acids (FFA), acylcarnitines, bile acids, and lysophosphatidylcholines. We found in detail 1) a strong decrease of all saturated and monounsaturated FFA studied during the oGTT; 2) a significant faster decline of palmitoleate (C16:1) and oleate (C18:1) FFA levels than their saturated counterparts; 3) a strong relative increase of polyunsaturated fatty acids in the fatty acid pattern at 120 min; and 4) a clear decrease in plasma C10:0, C12:0, and C14:1 acylcarnitine levels. These data reflect the switch from β-oxidation to glycolysis and fat storage during the oGTT. Moreover, the bile acids glycocholic acid, glycochenodeoxycholic acid, and glycodeoxycholic acid were highly discriminative, showing a biphasic kinetic with a maximum of a 4.5- to 6-fold increase at 30 min after glucose ingestion, a significant decrease over the next 60 min followed by an increase until the end of the oGTT. Lysophosphatidylcholines were also increased significantly. The findings of our metabolomics study reveal detailed insights in the complex physiological regulation of the metabolism during an oGTT offering novel perspectives of this widely used procedure.

scholarly journals MetAP2 inhibitor treatment of high-fat and -fructose-fed dogs: impact on the response to oral glucose ingestion and a hyperinsulinemic hyperglycemic clamp

2020 ◽  
Vol 318 (4) ◽  
pp. E514-E524
Author(s):  
Mary Courtney Moore ◽  
Katie C. Coate ◽  
Melanie Scott ◽  
Guillaume Kraft ◽  
James E. Vath ◽  
...  
Keyword(s):  
Glucose Tolerance ◽  
Tolerance Test ◽  
Glucose Infusion ◽  
Oral Glucose ◽  
Methionine Aminopeptidase ◽  
High Fat ◽  
Pilot Studies ◽  
Hyperglycemic Clamp ◽  
Glucose Ingestion ◽  
Control Versus

We examined the methionine aminopeptidase 2 inhibitor fumagillin in dogs consuming a high-fat and -fructose diet (HFFD). In pilot studies (3 dogs that had consumed HFFD for 3 yr), 8 wk of daily treatment with fumagillin reduced food intake 29%, weight 6%, and the glycemic excursion during an oral glucose tolerance test (OGTT) 44%. A second group of dogs consumed the HFFD for 17 wk: pretreatment ( weeks 0–4), treatment with fumagillin (FUM; n = 6), or no drug (Control, n = 8) ( weeks 4–12), washout period ( weeks 12–16), and fumagillin or no drug for 1 wk ( week 17). OGTTs were performed at 0, 4, 11, and 16 wk. A hyperinsulinemic hyperglycemic clamp was performed in week 12; 4 chow-fed dogs underwent identical clamps. Kilocalories per day intake during the treatment period was 2,067 ± 50 (Control) versus 1,824 ± 202 (FUM). Body weights (kg) increased 1.9 ± 0.3 vs. 2.7 ± 0.8 (0–4 wk) and 1.2 ± 0.2 vs. −0.02 ± 0.9 (4–12 wk) in Control versus fumagillin. The OGTT glycemic response was 30% greater in Control versus fumagillin at 11 wk. Net hepatic glucose uptake (NHGU; mg·kg−1·min−1) in the Chow, Control, and fumagillin dogs was ~1.5 ± 0.6, −0.1 ± 0.1, and 0.3 ± 0.4 (with no portal glucose infusion) and 3.1 ± 0.6, 0.5 ± 0.3, and 1.5 ± 0.5 (portal glucose infusion at 4 mg·kg−1·min−1), respectively. Fumagillin improved glucose tolerance and NHGU in HFFD dogs, suggesting methionine aminopeptidase 2 (MetAP2) inhibitors have the potential for improving glycemic control in prediabetes and diabetes.

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