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4,5 Diabetic peripheral neuropathy (DPN), the most common form of DN, is characterized by distal symmetric polyneuropathy, leading to sensory loss, pain, and motor dysfunction in the extremities and is a primary cause of foot ulcers and lower-limb amputations in diabetes patients

and 4) wound remodeling with scar tissue formation

A general finding is that obese patients fulfilling criteria for MetS together with low IGF-1 plasma levels tend to develop a worse cardiovascular disease outcome than those with mid-normal to high-normal IGF-1 levels [213]

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The proposed mechanism involves maintaining synaptic vesicle integrity, competing for receptor sites, and potentially substituting for depleted neurotransmitters