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Sirtuin 1 (SIRT1) negatively regulates GH-induced IGF-1 production in the liver by directly inhibiting signal transducer and activator of transcription 5 (STAT5) activation, which causes GH resistance under prolonged fasting, starvation, and malnutrition [6]

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This difference is consistent with patterns observed for semaglutide and tirzepatide across diabetic vs