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Over time, exposure to environmental pollutants, processed foods, alcohol, and medications can overwhelm the liver, leading to poor detoxification and increased oxidative stress[7]

Additional sensitivity analyses using stricter outcome definitions and alternative cohort criteria yielded findings that were directionally similar, though some estimates became less precise due to smaller sample sizes

The result is a synergistic GH secretion profile that neither compound achieves in isolation, combining GHRH-receptor-driven cAMP/PKA somatotroph amplification with GHS-R1a-mediated intracellular calcium mobilisation for a physiologically pulsatile, dual-pathway GH response

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Owing to the progressive nature of the disease, most patients ultimately require a combination of pharmacological therapies to achieve glycaemic control [1,2,3]