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Under these conditions, the increased secretion of counterregulatory hormones stimulates FFAs oxidation in the liver and accelerates the production of ketone bodies, which are metabolized in muscle, adipose tissue and, most importantly, in heart and brain ( As demonstrated in a recent meta-analysis, SGLT-2i treatment is associated with increased plasma fasting glucagon levels in patients with diabetes compared with non-SGLT-2i treatments with a reduction of insulin and increased ketone body levels ( via GH upregulation
Additionally, GLP-1 has been shown to enhance the proliferation and differentiation of endothelial progenitor cells through upregulation of VEGF, potentially promoting angiogenesis that could contribute to retinal complications [101,102]
Any episode of syncope (loss of consciousness) requires immediate medical assessment, as this may indicate significant hypotension or other serious conditions requiring investigation
