Patient description: The patient is a 34-year-old obese woman who comes to the clinic with weight concerns. She is 165 cm tall, and her weight is 113 kg (BMI: 41.5). In the past, she unsuccessfully used antiobesity agents and appetite suppressants. She is complaining of sleep apnea, PCO and dissatisfaction with her body shape. She is a high-school teacher. She is married for 5 years. She doesn't use any contraceptive methods for the past 4 months and she had no prior pregnancies. She rarely exercises and movement seems to be hard for her. She is not able to complete the four-square step test in less than 15 seconds. She does not smoke or use any drugs. Her BP: 130/80, HR: 195/min and her BMI is: 41.54. Her lab results: FBS: 98 mg/dl TG: 150 mg/dl Cholesterol: 180 mg/dl LDL: 90 mg/dl HDL: 35 mg/dl She is considering a laparoscopic gastric bypass.

Clinical trial eligibility criteria: eligible ages (years): 18.0-75.0,  Type 2 Diabetes Gender: men and women 2. Ethnicity: all ethnic groups 3. Language: English 4. Age: ≥ 18 to 75 years 5. Type II diabetes Currently treated with MDI (basal/bolus regimen) for at least 6 months MDI must consist of three or more injections of insulin per day, with at least 2 injections being prandial/rapid-acting insulin Prandial insulin restricted to insulin aspart, glulisine, and lispro Basal insulin restricted to long acting once-daily analogues (insulin glargine U- 100, insulin degludec (U-100 or U-200), or insulin glargine U-300) A1C within 30 days of randomization must be ≤ 7.5% on the present therapy Less than or equal to 80 units of total insulin therapy per day 6. Ability to provide informed consent before any trial-related activities. Trial-related activities are any procedure that would not have been performed during normal management of the subject  GAD-65 antibody positive 2. Glomerular Filtration Rate <30 mL/min per 1.73 m2 (calculated by the Chronic Kidney Disease Epidemiology Collaboration Equation, CKD-EPI) 3. Current glucocorticoid therapy 4. Known or suspected allergy to trial medication(s), excipients, or related products, i.e., GLP-1RA therapy or insulin aspart or insulin degludec. 5. The receipt of any investigational drug within 90 days prior to this trial. 6. Previous participation in this trial (Randomized) 7. Mental incapacity or language barrier (non-English speaking) 8. Use of incretin-based therapies <3 months before in the study DPP-4 inhibitors sitagliptin, saxagliptin, linagliptin, alogliptin GLP-1RA (exenatide, liraglutide, exenatide LAR, dulaglutide, albiglutide, lixisenatide, semaglutide) GLP-1RA/Basal Insulin combination (IGlarLixi, IDegLira) 9. Present use of oral anti-diabetic agents other than metformin. The dose of metformin must be unchanged and stable for the immediate 3 months prior to baseline. 10. Pregnant, breast-feeding or the intention of becoming pregnant or not using adequate contraceptive measures 11. Personal or family history of medullary thyroid carcinoma 12. Personal or family history of Multiple Endocrine Neoplasia syndrome type 2 13. History of acute or chronic pancreatitis, severe liver disease or LFT's > 2.5X ULN, or severe disease of digestive tract 14. History of bariatric surgery/procedure (gastric banding, gastric sleeve, or Roux-en-Y) 15. Known elevation of serum calcitonin > 50 ng/L