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While TBIR most frequently occurs in middle-aged African American women, cases in younger patients and other ethnic groups, including Asian and Hispanic populations, are increasingly recognized ( TBIR is often accompanied by weight loss and dermatologic signs of insulin resistance such as acanthosis nigricans ( INSR gene variants highlights that these episodes are typically triggered by underlying infections and often necessitate massive insulin doses

Several studies have also indicated that GLP-1 levels and responses to meals may be altered in obese subjects

3B, D), which reflects a shift in metabolism towards increased fat oxidation

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