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The case underscores the importance of maintaining a high index of suspicion for TBIR in patients with severe insulin resistance, especially when also presenting with cachexia, acanthosis nigricans, preserved C-peptide, or autoimmune serologies, even in young individuals without a prior diagnosis of systemic autoimmune disease

Type 2 diabetes improvement occurs in many patients taking semaglutide for weight management, with some achieving normal fasting glucose levels and HbA1c reductions exceeding 1.5%

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