Round 2 Open Questions
Answered this round
- Gallbladder disease rates: ✓ Composite RR 1.97 (significant); individual components ≤1%
- Pancreatitis: ✓ Not significantly increased in RCT meta-analyses
- Discontinuation rates: ✓ 3–10% dose-dependent
- Guidelines (ADA 2023/2024): ✓ Added; positioned as preferred agent for T2D+obesity
- Circulation claims: ✓ Classified as “weak” evidence — only indirect biomarker and risk factor data
- Patient feedback overview: ✓ Drugs.com 8.5/10, ~70% positive; mixed GI tolerance
Still unanswered
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T2D-specific patient feedback (50+): Reviews aggregated across T2D and obesity users. Need Reddit r/diabetes and HealthUnlocked T2D threads specifically reporting experience in patients 50+ with long diabetes duration, on insulin.
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Gastroparesis and retinopathy risks: FDA label mentions gastroparesis-like symptoms and retinopathy worsening (rapid glucose reduction can transiently worsen diabetic retinopathy). Absolute rates not yet captured.
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NICE guidelines (UK) and KDIGO 2022 diabetes and CKD: Specific recommendations for tirzepatide in UK practice and in CKD patients. NICE approved; positioning details missing.
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Stopping effects / treatment dependence: What evidence exists for tirzepatide washout? Weight regain and glycaemic rebound after stopping. SURMOUNT-4 washout data for obesity — relevance to T2D unclear.
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Advanced T2D on basal-bolus insulin: SURPASS-6 covers basal insulin + tirzepatide vs adding prandial. What about patients on full basal-bolus regimens (high total daily insulin >80U)? No specific SURPASS data.
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SURPASS-3 detailed data: HbA1c, weight, and insulin dose reduction data for SURPASS-3 (vs insulin degludec) still need a dedicated trial note.
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SURPASS-CVOT results: Trial vs dulaglutide in T2D with established ASCVD — results not yet available in knowledge base.