One way to circumvent the problem of lack of cost savings is to better target reimbursement by stratifying subgroups of obese patients into those expected to benefit the most versus those for whom the return isnt as good
As an amino acid derivative it carries a carboxylate and a hydroxyl group on a trimethylammonium backbone, and it exists as a zwitterion (inner salt) at physiological pH
Consider initial therapy at this stage when blood glucose 300 to 350 mg/dL (16.7 to 19.4 mmol/L) and/or HbA1C 10%-12% (86 to 108 mmol/mol), especially if the patient is symptomatic or if catabolic features (eg, weight loss, ketosis) are present, in which case basal insulin + mealtime insulin is the preferred initial regimen
A coordinated integrated-care plan that addresses all three together often unblocks weight loss in ways a GLP-1 alone cannot
Cognitive-behavioral therapy, mindfulness practices, and, when appropriate, psychiatric medication can address these contributors to brain fog
& Xu, B