A 45-year-old woman presents to her primary care physician because of fatigue, difficulty sleeping; muscle and joint pain, especially in her legs; and decreased ability to maintain physical exertion for long periods of time. She has spent the past several years as the primary caregiver for her parents, who have since died, and has two teenage children. She has gained 40 lb in the past 5 years. Her height is 5 ft 3 in and weight is 190 lb (BMI, 33.7). Physical exam reveals a blood pressure of 150/90 mm Hg. Laboratory tests reveal a fasting glucose level of 150 mg/dL and A1c of 6.4%. Her medical history is otherwise unremarkable.