All 30 individuals had obesity (25 had severe obesity): 13 started insulin at the time of T2D diagnosis, 17 started insulin after HbA1c rose to 8% at a median time of 21 (range, 2-53) months postdiagnosis, and 4 discontinued insulin with subsequent HbA1c less than 8% (eFigure in Supplement 1). This evidence concerns the gene INS and obesity due to melanocortin 4 receptor deficiency.