From 2007 to 2018 the proportion of children and adolescents receiving higher doses of insulin and using insulin analogs continued to increase to 100% in 2018, but the prevalence of overweight and obesity observed did not change from 2007 to 2018 (Figs. 3 and 4), in contrast to other studies [27]. Here, INS is linked to obesity due to melanocortin 4 receptor deficiency.