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This triggers a dual effect on: Glucose-Dependent Secretion: The rise in cAMP activates Protein Kinase A (PKA) and Epac (Exchange Protein directly activated by cAMP)

156 The unfolded protein response (UPR) helps to re-establish endoplasmic reticulum (ER) homeostasis and promote cell survival

LDSFs mainly target vascular endothelial cell, vascular smooth muscle cells, cardiomyocytes, fibroblasts, macrophages and platelets, and further modulate endothelial nitric oxide synthase/nitric oxide, endothelial function, energy metabolism, inflammation, oxidative stress, and dystrophic calcification

Current evidence remains limited, with most clinical experience coming from case reports and small observational studies rather than large randomized trials