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J Clin Invest 79: 616-619, 1987

Several clinical scenarios warrant discussion: You should consider speaking with your GP if: You have type 2 diabetes that is inadequately controlled despite lifestyle modifications and metformin therapy, and your HbA1c remains above target You are struggling with weight management despite optimised thyroid hormone replacement, and you might meet NICE criteria for medical weight management (typically requiring referral to specialist weight management services) You have cardiovascular disease alongside type 2 diabetes, as some GLP-1 agonists (semaglutide, liraglutide, dulaglutide) have demonstrated cardiovascular benefits Your current diabetes medications are causing problematic side effects or hypoglycaemia Before your appointment , it is helpful to: Ensure your thyroid function has been checked recently (within the past 6 months) Compile a list of all current medications, including levothyroxine dose and timing Document your weight history and any previous weight management attempts Note any family history of thyroid cancer or endocrine conditions Prepare questions about potential benefits, risks, and alternatives Your GP will assess your suitability for GLP-1 therapy by reviewing your medical history, current thyroid status, diabetes control (if applicable), and overall health

157,158 Activation of the insulin or Insulin-like Growth Factor 1 (IGF-1) receptor can enhance insulin sensitivity, improve glucose absorption and utilization by cells, and potentially have positive effects on cardiovascular health and long-term energy balance

In 2018, the recommendations of the international evidence-based guidelines for the assessment and management of PCOS [1] indicated that, although its use is generally off label, metformin can be considered in addition to lifestyle in women with PCOS and Body Mass Index (BMI) 25 kg/m 2 to potentiate weight loss and to improve endocrine and metabolic outcomes

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