For example, a hospital-based study in South Africa reported a high prevalence (83%)among participants with high obesity rates (BMI >30 kg/m2: 63% and central obesity: 95.4%) and complex treatment regimens combining insulin and metformin (56), whereas a study in Nigeria reported a lower prevalence (40%) among participants with lower obesity rates (18%), simpler treatment modalities, and better medication adherence (48). Here, INS is linked to obesity disorder.