INS and obesity due to melanocortin 4 receptor deficiency: The global diabetes epidemic does not affect primitive tribes and people continuing to live traditionally in regions of the world with a high number of centenarians and elderly people without disease or chronic health problems.37 All people with type 2 diabetes have insulin resistance, which renders insulin testing redundant in patients with severe obesity.38 Several biological and hormonal factors have been linked to the increasing global prevalence of metabolic syndrome.39