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The ominous octet (Defronzo model) includes: decreased muscle glucose uptake, increased hepatic glucose output, impaired incretin effect, alpha-cell hyperglucagonemia, increased renal glucose reabsorption (SGLT-2 upregulation), increased lipolysis (adipose), decreased central satiety signaling, and decreased beta-cell insulin secretion

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It is not the fault of the trainee doctor or nurse that this vital education is missing but countless patients have provided a valuable opportunity for CPD by providing information for those in qualified to be in charge of their care