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Enteroendocrine cells (EECs), the microbiota, and metabolites produced by the microbiota constitute a complex signaling system [13] that involves the enteric plexus, CNS afferents and efferents, and the modulation of numerous brain nuclei like the nucleus tractus solitarius, hypothalamus, thalamus, and many others directly involved in the control of glucose and energy homeostasis [14]

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Other risk factors include those of Native American or Mexican descent as well as those with metabolic syndromes such as obesity, hypertriglyceridemia, and insulin resistance