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Insulin gene expression is upregulated in pancreatic -cells after GLP-1R activation, which increases insulin mRNA expression through activation of transcription factors such as pancreatic and duodenal homeobox-1 and cAMP-response element binding protein (Table 1), contributing to an increase in -cell numbers (Liu et al., 2024)

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Eventually this can result in bone-on-bone rubbing and the development of painful bone spurs