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Other mechanisms include increased insulin resistance induced by high-dose glucocorticoids that increases intra-portal insulin, decreases IGFBP-1 that increases free IGF-I, and direct glucocorticoid effects in increasing hepatic IGF-I synthesis and decreasing hepatic insulin clearance (105)

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tirzepatide activates the GIP and GLP-1 incretin receptors and adds a glucose-dependent insulin-secretion effect that an amylin analog does not have