In the last step, CPT II enzyme activity converts acylcarnitine back to acyl-CoA's, which undergoes -oxidation, which involves dehydrogenation, hydration, another dehydrogenation, and thiolytic cleavage
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[11] It is worth noting that baseline HbA1c influences absolute reduction: individuals starting with higher HbA1c levels typically experience greater absolute reductions, though percentage reductions remain relatively consistent