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Instead, despite partial compensatory mechanisms, meta-inflammation sustains a self-reinforcing loop between stress signaling and insulin-pathway inhibition, promotes IR and endothelial dysfunction (endotheliosis), andunder hyperinflammatory conditionsmay progress toward overt endotheliitis, thereby contributing to cardiovascular disease and other T2DM complications

Hedges' g effect values of 0.20, 0.50 and 0.80 respectively represent small, medium and large effects ( Meta-analysis was performed using R Studio's Metafor package ( I 2 statistics for quantification and Cochran's Q for statistical significance test to evaluate heterogeneity