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Furthermore, in RINm5F cells exposed to high glucose, palmitate esters, or both, GA enhanced cellular survival pathways by upregulating Bcl-2 activity, downregulating caspase-3 activity, reducing DNA damage, weakening nuclear factor kappa-light-chain-enhancer of activated B cells (NF-B) signaling, and increasing the expression of insulin mRNA, thereby promoting insulin secretion (Sameermahmood et al., 2010)

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Starting metformin alongside intensive lifestyle modifications is advisable [] , and it is usually continued throughout treatment unless contraindicated