INS and obesity due to melanocortin 4 receptor deficiency: In adults with obesity and T2DM, Partanen et al. [55] investigated the occurrence and risk factors of DPN at five years after the diagnosis of T2DM(mean HbA1c 9.3%), when all subjects were treated with nutritional interventions alone, and after ten years of follow-up (mean HbA1c 9%) when treatment involved a combination of oral hypoglycemic agents and insulin.