SarahChen_PharmD said:

— in my experience this comes down to a few key factors

I respect SarahChen_PharmD perspective but I think this oversimplifies things a bit. Re: GLP-1 and gluconeogenesis — the subgroup analyses show meaningful heterogeneity.

I am not saying SarahChen_PharmD wrong entirely — just that the picture is more nuanced than a blanket statement. The SURMOUNT data specifically shows baseline BMI-dependent responses.

Relevant to GLP-1 and gluconeogenesis — here is my latest bloodwork comparison:

Key improvements: A1C 7.6% → 5.5%, triglycerides 225 → 95 mg/dL, hsCRP 8.0 → 1.3 mg/L. All on tirzepatide for 17 months.

The inflammatory marker drop is what impresses me most. Consistent with the SELECT trial's cardiovascular findings.

Thank you Dr.PulmRoch! This is incredibly helpful. Taking this to my next appointment. 🙏

Slightly tangential to GLP-1 and gluconeogenesis but SteveThurs reminded me — does anyone have experience combining this with metformin?

I know it is not exactly on-topic but it seems related enough to ask here rather than starting a new thread. Apologies if this has been covered — I did search first.

Moderator note: Great discussion, everyone. Just a reminder to keep things civil and evidence-based.

Thread quality is excellent — keep it up. 👍