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These cytokines also contribute to IR through mechanisms including inhibitory phosphorylation of insulin receptor substrate-1 (IRS-1) and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-B) pathway, while also promoting glucocorticoid resistance and HPA axis hyperactivity [80]
That makes them uncommon but not rare
In people with obesity or metabolic dysfunction, this signaling system is often impaired meaning the fullness and satiety signals don't fire the way they should
