Browse the evidence

Implementing a ketogenic diet (KD) with very-low carbohydrate intake (<50 g/day) significantly reduces fasting insulin levels and promotes substantial weight loss in patients with obesity and insulin resistance who have experienced weight regain after Roux-en-Y gastric bypass surgery.

If you have had weight loss surgery and are regaining weight, or if you are obese with high insulin but normal blood sugar, standard 'calorie counting' may not be enough. Consider a ketogenic diet (very low carb, high healthy fat) under medical supervision to lower insulin levels, which may help shift your body from storing fat to burning it, potentially leading to significant weight loss and reduced inflammation.

Tirzepatide, a dual GIP/GLP-1 receptor agonist, produces dose-dependent weight loss (up to 20.9% with 15 mg weekly dose) and is recommended for patients targeting 15-20% weight loss.

If you need to lose a significant amount of weight (15-20%), ask your doctor about tirzepatide. It is a once-weekly injection that works by mimicking two gut hormones (GIP and GLP-1). Start at a low dose to minimize side effects, and gradually increase it over several months to find the right dose for you. It is more potent than older GLP-1 drugs.

CagriSema (semaglutide + cagrilintide) produces superior weight loss (22.7% at 68 weeks) compared to semaglutide 2.4 mg alone (16.1%) or cagrilintide alone (11.8%).

If you have obesity and need maximum weight loss, ask your doctor about CagriSema. It combines two hormones (GLP-1 and amylin) into one weekly injection. Clinical trials show it can help you lose nearly 23% of your body weight, which is more than semaglutide or tirzepatide alone. It is currently in Phase 3 trials.

Blood pressure targets for most nonpregnant adults with T2DM should be <130/80 mmHg, with stricter targets (<1.8 mmol/L LDL-C) for those with atherosclerotic cardiovascular disease.

Manage your blood pressure to below 130/80 mmHg. If you have heart disease, aim for even lower LDL cholesterol (<1.8 mmol/L). This integrated control is crucial for preventing heart and stroke complications.

Benzodiazepines, benzodiazepine receptor agonists, and daridorexant are recommended for short-term treatment of insomnia (≤ 4 weeks), while orexin receptor antagonists may be used for up to 3 months or longer in some cases.

If CBT-I doesn't work well enough, your doctor may prescribe short-term sleep medication (like benzodiazepines or daridorexant) for up to 4 weeks. Do not exceed this duration without medical advice due to tolerance and dependence risks. Orexin antagonists may be used for up to 3 months in some cases.

Incretin-based therapies (e.g., semaglutide, tirzepatide) are advised for the optimal management of comorbidities like type 2 diabetes or obesity in adults with MASLD.

If you have type 2 diabetes or obesity, talk to your doctor about incretin-based therapies like semaglutide or tirzepatide, which can help manage these conditions and may benefit your liver.

Caffeine consumption reduces total sleep time by an average of 45 minutes and decreases sleep efficiency by 7%, with the magnitude of sleep loss increasing as the dose increases and the time of consumption approaches bedtime.

To protect your sleep, treat caffeine like a timed medication. If you drink a standard cup of coffee (approx. 107mg), stop consuming it at least 8.8 hours before you plan to sleep. If you consume a high-dose pre-workout supplement (approx. 217.5mg), you must stop at least 13.2 hours before bedtime. Consuming caffeine closer to bedtime will significantly reduce your total sleep time and efficiency, regardless of your habitual intake.

Subcutaneous semaglutide and SGLT-2 inhibitors (empagliflozin, canagliflozin, dapagliflozin, ertugliflozin) produce the greatest reductions in body weight and systolic blood pressure in patients with type 2 diabetes compared to other glucose-lowering medications.

For patients with type 2 diabetes seeking to lose weight and lower blood pressure, subcutaneous semaglutide and SGLT-2 inhibitors (like empagliflozin or canagliflozin) are the most effective pharmacological options. These drugs offer sustainable benefits over long-term treatment (>= 1 year) and may reduce the need for separate antihypertensive or lipid-lowering medications.

SGLT-2 inhibitors and GLP-1 RAs provide sustainable reductions in body weight and systolic blood pressure for over 52 weeks of treatment, unlike some other agents where effects may diminish.

For long-term management of type 2 diabetes, GLP-1 RAs and SGLT-2 inhibitors are preferred because their benefits on weight and blood pressure are sustained over a year or more. This makes them suitable for patients who need durable control without the weight gain associated with other medications like insulin or sulphonylureas.

For patients with type 2 diabetes and established cardiovascular disease, a combination of metformin and a glucagon-like peptide-1 (GLP-1) receptor agonist with proven cardiovascular benefits is recommended.

If you have Type 2 Diabetes and existing heart disease, your doctor should prioritize a treatment plan that includes Metformin plus a GLP-1 receptor agonist known to protect the heart. This combination is recommended over other options to reduce the risk of major cardiovascular events like heart attack or stroke.

For patients with Type 2 Diabetes and chronic kidney disease (CKD) or heart failure (HF), a sodium-glucose transporter protein-2 (SGLT-2) inhibitor with proven cardiovascular benefit is advised.

If you have Type 2 Diabetes along with kidney disease or heart failure, ask your doctor about SGLT-2 inhibitors. These medications are specifically advised because they have proven benefits for protecting your heart and kidneys.

Tirzepatide use, particularly with unsupervised dose escalation and caloric restriction, can cause euglycemic ketoacidosis (EKA) in non-diabetic patients.

If you are using tirzepatide, do not self-prescribe or self-escalate doses. Monitor for signs of metabolic acidosis (nausea, vomiting, abdominal pain, fatigue) especially if you are eating very little. Seek immediate medical attention if these symptoms occur, as they can signal euglycemic ketoacidosis, a rare but serious condition.

Tirzepatide treatment in premenopausal women with obesity is hypothesized to increase brown adipose tissue (BAT) volume and activity and induce white adipose tissue (WAT) browning, potentially mitigating the decline in resting energy expenditure typically associated with weight loss.

This paper outlines a clinical trial design, not a consumer guide. It hypothesizes that tirzepatide may help maintain metabolic rate during weight loss by activating brown fat and turning white fat 'beige'. The protocol involves weekly injections starting at a low dose and slowly increasing over 24 weeks, with close monitoring for side effects. No results are available yet.

Semaglutide increases the risk of adverse events, serious adverse events, and discontinuation due to adverse events compared to placebo, primarily driven by gastrointestinal reactions (nausea, diarrhea).

Be aware that semaglutide increases the risk of gastrointestinal side effects like nausea and diarrhea, which can lead to stopping the medication. These side effects are usually temporary and mild to moderate. The risk of discontinuation is higher than with a placebo, so monitoring and managing these symptoms is important for long-term success.

All GLP-1 analogs and agonists are associated with a higher risk of discontinuation due to adverse events compared to placebo, with taspoglutide and high-dose liraglutide having the highest risk.

Be prepared for a higher likelihood of side effects, particularly nausea and vomiting, when starting any GLP-1 medication. This may lead to discontinuation, especially with taspoglutide and high-dose liraglutide. Discuss side effect management strategies with your provider.

Semaglutide, a long-acting GLP-1 receptor agonist, is hypothesized to reduce arterial stiffness (measured by carotid-femoral pulse wave velocity) and improve cardiometabolic markers in adults with type 1 diabetes.

This paper describes a planned clinical trial, not a finished treatment guideline. It suggests that semaglutide might help people with Type 1 Diabetes who are overweight and have heart risk factors by improving blood vessel stiffness. Patients should discuss this emerging research with their endocrinologist, as the results are not yet available.

Long-term use of semaglutide (GLP-1 RA) may be associated with the development of exocrine pancreatic insufficiency, particularly in patients with concurrent chronic alcohol consumption.

If you are taking semaglutide or similar GLP-1 medications, be aware of potential pancreatic issues, especially if you drink alcohol. Report symptoms like fatty stools (steatorrhea) or abdominal pain immediately. Your doctor should monitor your lipase levels regularly.

SGLT2 inhibitors and GLP-1 receptor agonists provide multi-organ cardiorenal protection beyond glycemic control, with selection prioritized by phenotype (e.g., SGLT2i for heart failure/CKD, GLP-1RA for ASCVD/obesity).

If you have heart, kidney, or metabolic issues, ask your doctor about SGLT2 inhibitors or GLP-1 agonists. These drugs protect your heart and kidneys, not just your blood sugar. Your doctor might even be able to lower your doses of other blood pressure or diabetes pills, reducing your risk of side effects like low blood sugar or dizziness.

Non-steroidal mineralocorticoid receptor antagonists (ns-MRA) like finerenone reduce cardiovascular and renal risks in T2D+CKD patients, with hyperkalemia risk manageable through monitoring.

If you have diabetes and kidney disease, ask about finerenone. It protects your heart and kidneys. Your doctor will check your potassium levels regularly to ensure it is safe for you.

Tirzepatide treatment, particularly during dose escalation, is associated with an increased risk of acute duodenal ulcer perforation in patients with pre-existing untreated Helicobacter pylori infection.

If you are taking tirzepatide and experience persistent or worsening stomach pain, nausea, or vomiting that does not resolve, do not assume it is just a normal side effect. Seek medical attention immediately, especially if you have a history of stomach issues or H. pylori. Early detection of ulcers can prevent perforation.

High-dose tirzepatide (15 mg weekly) can induce severe gastrointestinal side effects (prolonged vomiting and diarrhea) leading to profound electrolyte imbalances (hypokalemia, hypomagnesemia, hypocalcemia), which precipitate life-threatening ventricular fibrillation and cardiac arrest.

If you are on 15mg tirzepatide and have persistent vomiting or diarrhea, do not ignore it. Ask your doctor to check your potassium, magnesium, and calcium levels immediately. Severe GI loss can trigger dangerous heart rhythms even if you have no prior heart history.

Evidence regarding the impact of GLP-1 RAs on total shoulder arthroplasty (TSA) outcomes is limited, heterogeneous, and contradictory, with some studies showing reduced mortality and adverse events while others show increased complications.

For shoulder replacement surgery, the data on GLP-1 RAs is mixed. Some studies show benefits like lower mortality, while others show higher risks of blood clots and pneumonia. Because the evidence is weak and contradictory, your surgical team will likely evaluate your specific case carefully. Do not assume the benefits seen in hip/knee surgery apply here without explicit guidance from your surgeon.

In patients with type 2 diabetes and high cardiovascular risk (CAC ≥ 100), intensified multifactorial treatment using SGLT2 inhibitors and GLP-1 receptor agonists combined with high-intensity lipid-lowering therapy reduces cardiovascular events compared to standard treatment.

If you have Type 2 Diabetes and a high Coronary Artery Calcification (CAC) score (≥100), current standard care may not be enough. This trial tests whether adding specific heart-protective diabetes medications (SGLT2 inhibitors and GLP-1 agonists) along with aggressive cholesterol and blood pressure management significantly reduces your risk of heart attack, stroke, or heart failure compared to standard care. You should discuss your CAC score and whether intensified therapy is appropriate for your specific risk profile with your doctor.

In patients with Type 2 Diabetes and a CAC score of 0 (very low risk), de-escalating multifactorial treatment targets (e.g., less intensive lipid and blood pressure management) is non-inferior to standard treatment regarding cardiovascular events.

If you have Type 2 Diabetes but a Coronary Artery Calcification (CAC) score of 0, your risk of a cardiovascular event is very low (about 1% over 5 years). This trial investigates whether it is safe to reduce the intensity of your cholesterol and blood pressure medications compared to standard care. If your CAC is 0, you might be able to simplify your medication regimen with your doctor, focusing on glucose control and avoiding side effects, without significantly increasing your heart risk.