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As we age, natural hormone production, cellular repair, and metabolic efficiency gradually decline

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The likelihood of pre-existing resistant clones is shaped by tumor size, baseline mutational burden, fitness costs, and microenvironmental constraints, making therapeutic failure an expected evolutionary outcome under strong selective pressure

However, when evaluating a person with diabetes and signs and/or symptoms of neuropathy, it is important to remember that DPN is not the only possible cause of these signs and/or symptoms and that rare diabetic neuropathies or even neuropathies of other etiologies may be present (74) ( Figure 1 )