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Among these, 31,407 (54.2%) participants were classified as engaged and 26,568 (45.8%) participants as nonengaged at baseline (month 0)

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In eye diseases like DR, high blood glucose and oxidative stress activate the Notch1-Hes signaling pathway, leading to ECM imbalance and promoting vascular dysfunction, inflammation, and retinal damage ( 2.5 Anti-angiogenic effect Abnormal angiogenesis plays a significant role in the pathogenesis of several eye diseases, particularly those involving retinal ischemia and neovascularization