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In obesity, hypertrophic expansion of adipocytes leads to hypoxia, oxidative stress, and the release of pro-inflammatory adipokines, thereby promoting insulin resistance and ectopic lipid deposition [31]

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Moreover, given no heterogeneous treatment effects found by age, gender, or diabetes severity for GLP-1RAs versus insulin in our previous analyses [6] and limited study subjects with different patient characteristics in the present study, performing the cost-effectiveness analysis stratified by different patient demographic or clinical characteristics would be infeasible