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Berberine increases intestinal L-cell GLP-1 production in vivo via stimulating the β-catenin/ T-cell factor 4 (TCF4) signaling pathway, as shown by Wang et al., 2021
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The lower achievement rates may be attributed to the effects of concomitant antidiabetic drugs, as demonstrated in PIONEER 3 study, as well as the potential presence of insulin resistance resulting from chronic poor glycemic control