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As discussed in greater detail in Section 2.6 of this review, the energy-producing cellular processes such as the mitochondrial tricarboxylic acid cycle (TCA) cycle and the electron transport chain (ETC) create ROS that have the potential to be toxic to cells if not regulated properly by antioxidant defense mechanisms such as GPX4 [125,126]

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While some studies found no difference between individuals with T2DM and matched non-diabetic controls (6769), others found plasma DPP-4 activity to be reduced in the patients, and suggested this might reflect a compensatory response to the reduced insulin sensitivity and hyperglycaemia, in an attempt to increase intact incretin hormone concentrations and improve insulin secretion (70, 71)

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Moderate for other peptides based on mechanisms and preliminary research