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SAM and NAD + serve as critical cofactors in cellular energy metabolism and redox states ( + levels, resulting in the upregulation of polyamine flux activation and increased energy expenditure ( FIGURE 2 3.2 NNMT and diabetes Diabetes is caused by a fundamental disturbance in the metabolism of glucose and is characterised by IGT, elevated fasting blood glucose, and inadequate insulin secretion or IR (Tripathi and Srivastava, 2006