Stockley, Elizabeth Sapey, Charlotte Summers, Andrew S
Many people managing type 2 diabetes or seeking weight loss explore different medication combinations
A comprehensive initial evaluation should include: Complete medical history: Previous weight loss attempts, family history of obesity, current medications (many cause weight gain), surgical history, and psychiatric screening for eating disorders Physical examination: BMI calculation, waist circumference, blood pressure, assessment for acanthosis nigricans, thyroid palpation, and evaluation for Cushing syndrome signs Laboratory workup: Complete metabolic panel, lipid panel, HbA1c, fasting insulin, thyroid panel (TSH, free T3, free T4), vitamin D, testosterone (in appropriate patients), and liver function tests Body composition analysis: DEXA scan or advanced bioimpedance analysis to establish baseline lean mass, fat mass, visceral fat, and bone density Metabolic rate testing: Indirect calorimetry to measure resting metabolic rate, which informs caloric targets far more accurately than estimation equations Psychosocial assessment: Screening for depression, anxiety, binge eating disorder, emotional eating patterns, and readiness for change Risk Stratification and Treatment Planning Based on the initial assessment, patients should be stratified into treatment tiers that align intervention intensity with clinical need
The SUPRPASS-4 trial (262), involving 2002 participants with high-risk cardiovascular profiles followed for up to 104 weeks, showed no difference in 4-MACE events (cardiovascular death, myocardial infarction, stroke, and hospitalization for unstable angina) with tirzepatide compared to insulin glargine (HR 0.74
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Further studies are needed to clarify the exact mechanisms by which KD influences the development of PP
