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FDA-APPROVED INDICATIONS Type 2 diabetes As an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients 10 years of age and older with type 2 diabetes mellitus Limitations of use: has not been studied in patients with a history of pancreatitis TYPE 2 DIABETES RCT SURPASS-2 trial - Tirzepatide vs Semaglutide in Patients with Type 2 Diabetes, NEJM (2021) [PubMed abstract] The SURPASS-2 trial enrolled 1879 adults with type 2 diabetes who were inadequately controlled with metformin at a dose of at least 1500 mg per day Main inclusion criteria Age 18 years T2DM uncontrolled with metformin at 1500 mg/day A1C of 7 - 10.5% BMI 25 and stable for 3 months Main exclusion criteria Type 1 diabetes GFR 50 ng/L

290 , 56965706 (2015) Lpez de Maturana, R., Treece-Birch, J., Abidi, F., Findlay, J

This effect could be particularly problematic in patients with pre-existing conditions affecting gastric motility

Maribel starts every patient at a conservative dose and titrates upward based on tolerance and response