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conversely, insulin can bind IGF1R with lower affinity than it has for the insulin receptor IGF1R and the insulin receptor can form heterodimers that bind both ligands IGF1 has actions distinct from those of growth hormone in carbohydrate, lipid and protein metabolism

Liver fat / NAFLD Later randomized trials reported meaningful reductions in liver fat

Patients with diabetes have many other associated comorbid conditions such as limited mobility, increased risk of infections, heart failure, lung problems, and chronic kidney disease

This increases the risk of dosing inaccuracies, contamination, or variable potency