INS and obesity due to melanocortin 4 receptor deficiency: Obesity and weight gain has negative impact on graft survival and is at least partially responsible for diabetes, which supports more focused, weight-centered approach to treatment.28-30 Although we were not able to show significant weight loss in our patients, the trend was a reduction in weight and significant decrease in insulin dose, which may have further beneficial effects on both weight loss and amelioration of hypoglycemic events.