Round 14 Open Questions
Answered this round
- Older T2D patients (≥65): ✓ SURPASS pooled post-hoc (n=540, ≥65 BMI <30): HbA1c and weight reductions consistent with overall population; hypoglycaemia no worse; but higher GI discontinuation — slower titration advised; no frailty or ≥75 data
- Stopping tirzepatide/rebound: ✓ T2D-specific 4-week washout (SURPASS-1): HbA1c rises within 4 weeks; SURMOUNT-4: >50% weight rebounds over 52 weeks; ~90% of prediabetes-protective effect lost within 17 weeks; tirzepatide is pharmacological disease management, not disease modification
Outstanding (lower priority — vault approaching completeness)
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Insulin reduction/cessation with tirzepatide: SURPASS-5/6 show tirzepatide can replace basal insulin in some patients. What are the clinical decision criteria for insulin dose reduction vs cessation? Any data beyond SURPASS-5/6 on full basal-bolus patients?
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Body composition monitoring in clinical practice: DXA available only in research settings. What practical monitoring (grip strength, weight, albumin) is recommended in T2D patients losing weight on tirzepatide, particularly older patients?
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NHS TA924 long-term access and continuation criteria: UK-specific — what proportion of T2D patients who start Mounjaro on NHS actually meet 3% weight loss at 6-month review criterion? Are there NHS real-world continuation data?