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doi: 10.1016/j.jdiacomp.2011.03.002

JAMA Network Open 7(5):e2413172 Valentine WJ, Hoog M, Mody R, Belger M, Pollock R (2023) Long-term cost-effectiveness analysis of tirzepatide versus semaglutide 1.0 mg for the management of type 2 diabetes in the United States

In these circumstances, the pyruvate generated by the actions of mitochondrial malic enzyme comes from fumarate precursors such as glutamine