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A treatment paradigm shift is recommended in which combination therapy is initiated with diet/exercise, metformin (which has antiatherogenic effects and improves hepatic insulin sensitivity), a TZD (which improves insulin sensitivity and preserves -cell function with proven durability), and a GLP-1 analog (which improves , -cell function and promotes weight loss) or a DPP-IV inhibitor (Fig

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Nearly one-third of patients report a family history of migraine