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Concerns that require attention: carpal tunnel-style tingling (signals excessive GH/IGF-1), elevated fasting glucose, persistent joint pain, and rare immunogenicity reactions

The incidence is relatively low, affecting less than five percent of patients with pre-existing retinopathy, but regular ophthalmologic monitoring is recommended for patients with diabetes-related eye disease

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Nicotinamide riboside (NR), also a precursor to NAD+, has demonstrated benefits in the context of neurodegenerative diseases