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Activation of GLP-1R leads to an increase in intracellular cAMP and/or calcium, triggering signaling pathways including protein kinase A (PKA), exchange proteins directly activated by cAMP (Epac-2), phospholipase C (PLC), and extracellular signal-regulated kinase 1 and 2 (ERK1/2), thereby mediating effects on glycemic regulation, immune process, and inflammation

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The improvement may reflect easing drug shortages, expanded insurance coverage and better management of side effects

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