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Long term safety concerns Long term use of GLP-1RA may increase the risk of medullary thyroid cancer (MTC), as well as gastrointestinal side effects (such as nausea, vomiting, diarrhea) and the risk of acute pancreatitis

Sitagliptin in Combination with Metformin Immediate-Release and Glimepiride In a 24-week placebo-controlled study of sitagliptin 100 mg as add-on therapy in patients with type 2 diabetes inadequately controlled on metformin immediate-release and glimepiride (sitagliptin, N=116

1220+ pounds over 16 weeks with muscle preserved

Cortisol and stress hormones Caloric restriction elevates cortisol

Improving metabolic health with tirzepatide helps with weight loss and other metabolic issues