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Reported cases have occurred primarily in diabetic patients with significant renal insufficiency, including both intrinsic renal disease and renal hypoperfusion, often in the setting of multiple concomitant medical/surgical problems and multiple concomitant medications

That's a muscle-preservation strategy

Given the importance of glucose and glutamine metabolism in pancreatic cancer cells, it is not surprising that gemcitabine resistance is closely associated with metabolic status, including cellular glucose and glutamine levels

The sensitivity analysis excluding one trial with a short duration and one trial that recruited participants on background insulin therapy yielded similar results and reduced statistical heterogeneity