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Furthermore, animal and in vitro studies implicate TMAO as a causal factor in the development of cardiovascular disease through mechanisms involving endothelial dysfunction 23,24,25 , inflammation 26 , foam cell formation 27 , and fibrosis 28

Of note, it is well-established that a rapid decrease in HbA1c can worsen diabetic retinopathy, particularly in patients with long-term and uncontrolled diabetes [71]