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Referral to specialists should be considered when patients have persistent A1C elevations despite combination therapy, complex obesity requiring specialized care, or when evaluating bariatric surgery options (typically for BMI 40 kg/m or 35 kg/m with comorbidities)

Nevertheless, the observations are interesting and have been subsequently followed up by a study that showed 12 weeks of daily carnitine and carbohydrate feeding in humans increases skeletal muscle total carnitine content and prevents body mass accrual associated with carbohydrate feeding alone (3)

What result would be realistic, and what would make us stop