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Tumour necrosis factor, IL-1 and IL-6 also cause cardiac myocyte hypertrophy and fibrosis and have negative inotropic effects, so may directly contribute to progression of disease

The process works as follows: Stimulates Growth Hormone Release: Certain peptides bind to the growth hormone secretagogue receptors (GHS-R) in the pituitary gland, thereby promoting the natural release of human growth hormone (HGH), which leads to increased lean muscle mass

These drugs are injectable and not recommended as primary treatment for DM