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QUESTION 25 Mr. Lopez is a 51~year~old male patient who is being treated for T2DM. His HgbAlc is 15.6% and initial management will include aggressive attempts for weight reduction as his
body mass index (Bil-1|} is 45. He says he is unable to participate in any meaningful exercise because he very ofizen has back pain; he has had it for years and has tried all sort of over
the counter medicines with little relief. He describes it as a profound ache that occurs across
the lower part of his back bilaterally; it does not travel down either leg. The physical
inspection is normal, but he has significant paraspinal tenderness to palpation bilaterally. He