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Hypothesised causes include: reduction in endogenous glucagon-like peptide-1 (GLP-1) levels in patients with MASLD and type 2 diabetes, reduction of glucose-dependent insulinotropic polypeptide (GIP) receptors or substrates involved in GIP signalling, and increased hepatic expression of dipeptidyl peptidase-4 (DPP-4), an enzyme that degrades GLP-1, diminishing systemic levels of active GLP-1 [1618]