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The evidence strongly suggests it is structural, not cyclical

DPP-4 Abstract: Two main patophysiological mechanisms are currently involved in Type 2 Diabetes (T2DM), insulin resistance and impairment of beta cell function

Open scientific questions Important gaps remain

Zafar Y, Rashid AM, Siddiqi AK, Ellahi A, Ahmed A, Hussain H, et al

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Patients should not attribute all abdominal symptoms to expected drug side effects without medical evaluation, particularly if symptoms are severe, persistent, or accompanied by alarm features