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These signaling cascades produce tissue-specific effects: hepatic IGF-1 production for endocrine growth signaling, muscle protein synthesis and glucose uptake, adipose tissue lipolysis, bone formation, and immune cell modulation

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A number of recent studies have linked the development of DPN to poor glycemic management, diabetes duration, hyperlipidemia (especially hypertriglyceridemia), higher albumin excretion rates, and obesity