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For diabetes GLP-1s (Ozempic, Mounjaro), PA usually requires A1c above 7.0%, prior metformin trial (or contraindication), and sometimes a second-line agent trial

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Conversely, [U- 13 C]glucose tracing showed GGCT overexpression enhanced Glc-derived carbon flux into the TCA cycle (increased m + 2 labeling of succinate, fumarate, malate), which was reversed by the E98A mutant (Fig