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These multimers promote vascular intima injury, which increases endothelial permeability, monocyte adhesion, and macrophage accumulation, leading to plaque development ( The polyol pathway consumes up to 30% of intracellular glucose under hyperglycemic conditions, with aldose reductase converting glucose to sorbitol in an NADPH-dependent reaction that depletes this critical cofactor required for glutathione reductase activity (Gupta, 2024)
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