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When calorie intake declines, the body adapts by lowering total energy requirements, which can include modest reductions in lean tissue. Mechanical load and mechanotransduction Skeletal muscle depends on mechanical stress to maintain size and strengtha process governed by mechanotransduction . Example : If a person weighs 250 lb, their muscles perform constant load-bearing work

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When symptoms appear, they may reflect fluid buildup, waste buildup, anemia, or blood pressure changes

In both patient populations with pre-existing cardiovascular disease, DPP-4 inhibitors are recommended as one possible third-line therapy besides SGLT-2 inhibitors, thiazolidinediones, or insulin, when therapeutic goals are not met with the previous dual combination