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Hyperglycemia alters both extracellular and intracellular metabolism, leading to effects such as glomerular hyperfiltration (4), oxidative stress (5), the accumulation of advanced glycation end products (AGEs) (6), the activation of protein kinase C (7), abnormal polyol metabolism (8), the overexpression of transforming growth factor- (TGF-) (9) and inflammation

An alternative mechanism (not mutually exclusive with reward modulation) is suggested by a study on nicotine, namely, that GLP1 receptor stimulation may promote satiety and avoidance of aversive effects of the drug, in this case nicotine, via a habenuladependent mechanism (Tuesta et al., 2017)

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With our cast of characters in place, glucose, insulin, glucagon, GLP-1, GIP, and SGLT2, we can now move into the pharmacological management of diabetes with much more context for why each medication class works the way it does

A patient is losing weight steadily, HbA1c levels are improving, and confidence is high during every follow-up visit

doi:10.7759/cureus.34723 OBrien PE, Hindle A, Brennan L, et al