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42,43 Of note, Abbass et al did not control for hemoglobin A1c, lipid levels, or history of cataract surgery, which could introduce bias

This metabolic adaptation is critical because of the reduced entry of pyruvate into the TCA cycle by activated PDK1 and the increased lactate secretion in hypoxia 66

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however, while it effectively lowers glycated hemoglobin (HbA1c), it has minimal effects on weight loss and limited durability in glycemic control