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A 2020 review in Diabetes Care noted that "the hypoglycaemic effect of IGF-1 has been exploited therapeutically in rare forms of insulin-receptor-defect syndromes, but the risk-benefit calculation differs fundamentally from use in euglycaemic individuals" [20]

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The modifications that make flmodafinil and fladrafinil more potent than the parent compound also introduce unknown variables regarding their effects on the cardiovascular system, neurological function, and potential for dependence