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They consist of mitochondrial dysfunction affecting the cellular energy metabolism, calcium homeostasis in the heart affecting contractility of the myocardium, changes caused to the protein structure and function such as proteins in the extracellular matrix and contractile proteins, and post translational modifications that occur like O-GlcNAcylation and lysine - hydroxybutyrylation which are dysregulated in the diabetic heart (112)

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However, findings on gonadotropin levels were mixed