“…Free D-xylose molecules significantly stimulate the biosynthesis of HS, CS, and DS [ 54 , 55 , 56 , 57 , 58 ]. Thus, insulin stimulates the biosynthesis of cell-layer GAGs, since it helps transport more D-xylose into the cell, which then stimulates the biosynthesis of GAGs, as confirmed by a previous study [ 59 ]. In addition, in 2009, Han et al [ 60 ], in a study on changes in HS of endothelial cells in diabetes, showed that high glucose or insulin levels alone reduced endothelial GAGs, but the presence of both simultaneously, i.e., hyperglycaemia + insulin, preserved GAGs [ 60 ].…”