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Vicious cycle of hyperglycemia and GIIS initiating another vicious cycle of increased lipolysis/elevated NEFA and reduced GIIS. The combination of these two vicious cycles may account for the progression of T2DM. The slight initial increase in plasma glucose that initiates the vicious cycles may be caused by age-dependent insulin resistance or reduced β-cell metabolism and ATP production that culminates in T2DM. See Section X.A.3.
