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The metabolic hypothesis the earliest and still the most widely cited attributes most downstream benefits to reduced caloric intake and improved insulin sensitivity
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When infused at a rate to mimic conditions after a meal, the hormone prodded the pancreas to crank out more insulin

Shah SJ et al (2022) Atrial shunt device for heart failure with preserved and mildly reduced ejection fraction (REDUCE LAP-HF II): a randomised, multicentre, blinded, sham-controlled trial, (in eng)