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Mechanistically, HPE enhanced insulin signaling by increasing the phosphorylation levels of insulin receptor substrate 1 (IRS1), phosphoinositide 3-kinase (PI3K), protein kinase B (AKT), and glucose transporter type 4 (GLUT4) in the liver, thereby activating the IRS1PI3KAKTGLUT4 pathway and improving insulin resistance

Footnotes The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article

An increase in concentration of serum l-carnitine can increment l-carnitine transportation through skeletal muscles and neuromuscular junctions

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