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Important considerations include: Tirzepatide is not indicated for type 1 diabetes or diabetic ketoacidosis and is not a substitute for insulin No dose adjustment is required in renal impairment, but patients should be monitored for dehydration risk, particularly with significant gastrointestinal side effects Caution is advised in patients with a history of pancreatitis Warnings and precautions apply for patients with personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 Prescribing in primary care requires initiation at 2.5 mg once weekly for 4 weeks (a non-therapeutic starting dose to improve tolerability), then escalation to 5 mg weekly

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Increased VAT could expose the liver to excessive fatty acids and glycerol via portal lipid flux, and then cause increased hepatic glucose and triglyceride production and decreased insulin clearance, thus leading to hepatic IR [35, 39, 40]

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