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This cellular energy crisis directly manifests as the profound physical fatigue, "brain fog," and post-exertional malaise (PEM) that patients experience

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Therefore, the inhibition of SGLT2 may reduce the activity of URAT1 by enhancing luminal glucose transmission or lowering insulin levels, or SGLT2 and URAT1 may functionally interact in the proximal tubule, thereby inhibiting SGLT2 to partially suppress URAT1 (Novikov et al., 2019