Round 6 Open Questions
Answered this round
- KDIGO 2022 CKD guidelines: ✓ Metformin → SGLT2i (1A, eGFR ≥20) → GLP-1 RA (1B, incl. tirzepatide); tirzepatide 3rd line in T2D+CKD; SGLT2i have stronger evidence
- Lean body composition / muscle mass: ✓ SURMOUNT-1 DXA: ~75% fat, ~25% lean of weight lost — proportional, not disproportionate; muscle quality (MFI) improved vs degludec; still no T2D-specific older adult data
Still unanswered
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Advanced T2D on basal-bolus insulin (TDD >80U): No specific SURPASS data. SURPASS-6 covers basal insulin; SURPASS-3 covers insulin-naive. What happens clinically to patients on full basal-bolus regimens? Clinical guidance and real-world experience?
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EASD 2022 position statement: European positioning of tirzepatide — where does the European Association for the Study of Diabetes place tirzepatide relative to SGLT2i and GLP-1 RAs?
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Liver disease (MASLD/NAFLD) outcomes: SURPASS-3 MRI substudy shows liver fat reduction. Any dedicated MASLD/NAFLD clinical outcomes data? Is there an ongoing tirzepatide MASLD trial?
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Tirzepatide in patients with eGFR <30: SURPASS-4 included CKD patients — what were the safety data for patients with advanced CKD (eGFR <30)? Is tirzepatide safe in this population?
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Patient feedback from NHS/UK patients (HealthUnlocked): UK-specific experience with Mounjaro on NHS — access, cost impact removed, older T2D patients.