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t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with insulin and sulfonylureas.

22 questions · sorted by votes

38 votes 5 answers43k views
What does a payer want to see before approving dulaglutide?

The pharmacy is accredited and I have verified that on the accreditor register. This is a procedural question rather than a theoretical one, and I would like the…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
dulaglutide
dulaglutide

A once-weekly GLP-1 receptor agonist built on an Fc fusion rather than fatty-acid acylation. Use this tag for questions about the fusion-protein…

200 questions
asked by sinead_gaffney 28k · 20 months ago
36 votes 3 answers19k views
If HbA1c is a 90-day average, what does a 0.5-point fall actually mean in glucose?

My HbA1c went from 7.4% to 6.9% over four months on semaglutide. Everyone tells me half a point is good. Nobody has told me what half a point is , in units I can…

a1c
a1c

Glycated haemoglobin as a ninety-day glycaemic average: what a change of half a point means, why it lags, and the conditions under which it…

122 questions
bloodwork
bloodwork

Laboratory monitoring: which panels are worth ordering, sensible intervals, reference-range versus optimal-range arguments, and how to read a…

296 questions
dosing-math
dosing-math

The arithmetic itself: milligrams to millilitres to insulin units, concentration after reconstitution, dose per draw, and vial-days per vial. Show…

764 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
asked by p_mkhize 58k · 21 months ago
32 votes5 answers29k views
What does a payer want to see before approving orforglipron?

The pharmacy is accredited and I have verified that on the accreditor register. Everything I have found on this is either a forum aside or a product page, neither of…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
orforglipron
orforglipron

A non-peptide, orally bioavailable small-molecule GLP-1 receptor agonist studied in the ATTAIN programme. It is not a peptide, which changes…

219 questions
asked by s_bhattacharya 31k · 18 months ago
32 votes 3 answers11k views
When does HbA1c lie? My A1c dropped 0.7 with no change in my CGM average

Two data streams disagreeing, and I cannot reconcile them. Over eleven weeks my HbA1c fell from 7.1% to 6.4%. Over the same eleven weeks my sensor mean glucose was…

a1c
a1c

Glycated haemoglobin as a ninety-day glycaemic average: what a change of half a point means, why it lags, and the conditions under which it…

122 questions
bloodwork
bloodwork

Laboratory monitoring: which panels are worth ordering, sensible intervals, reference-range versus optimal-range arguments, and how to read a…

296 questions
kidney-function
kidney-function

eGFR, creatinine, cystatin C and albuminuria: the acute haemodynamic dip that is not injury, the renal outcome data from the FLOW programme, and…

141 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
asked by seamus_brady 15k · 11 months ago
29 votes 4 answers22k views
What does a payer want to see before approving ecnoglutide?

The pharmacy is accredited and I have verified that on the accreditor register. I am trying to do this correctly the first time rather than learn it by getting it…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
ecnoglutide
ecnoglutide

A long-acting GLP-1 receptor agonist with a cAMP-biased signalling profile. A niche tag, mostly used for mechanism questions about biased agonism…

223 questions
asked by dmitri_savchuk 27k · 10 months ago
24 votes 5 answers19k views
What does a payer want to see before approving oral semaglutide?

I have the plan documents and the written criteria, which took two calls to obtain. I want a method I can write down and repeat, not a rule of thumb. I would rather…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
oral-glp1
oral-glp1

Oral routes for GLP-1 receptor agonism: peptide formulations rescued by absorption enhancers such as SNAC, and true small molecules that need no…

219 questions
asked by jana_horakova 10k · 20 months ago
22 votes5 answers16k views
What is the interaction with a sulfonylurea worth knowing about?

I am reading the trial table rather than the press release, which is why the numbers differ. I would like the mechanism, because I want to be able to reason about the…

t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
a1c
a1c

Glycated haemoglobin as a ninety-day glycaemic average: what a change of half a point means, why it lags, and the conditions under which it…

122 questions
harm-reduction
harm-reduction

Reducing avoidable risk where a decision has already been made: independent verification before use, sterility practice, dose arithmetic checked…

472 questions
asked by imani_dube 8.9k · 9 months ago
22 votes 5 answers8.5k views
How do I convert an HbA1c to an estimated average glucose?

The clinician who ordered the panel was not concerned; I would still like to understand it. I want the working, not the result — I need to be able to redo it with…

a1c
a1c

Glycated haemoglobin as a ninety-day glycaemic average: what a change of half a point means, why it lags, and the conditions under which it…

122 questions
dosing-math
dosing-math

The arithmetic itself: milligrams to millilitres to insulin units, concentration after reconstitution, dose per draw, and vial-days per vial. Show…

764 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
asked by Dr_Malik_Osei 19k · 6 months ago
20 votes 5 answers20k views
Does glucagon receptor agonism cost glycaemic control at the top doses?

This matters because it predicts what a related molecule should do. I keep seeing this stated as a fact with no explanation attached, and unexplained facts make me…

glucagon-receptor
glucagon-receptor

Glucagon receptor agonism as a deliberate component of dual and tri-agonists: what it adds in energy expenditure and hepatic fat mobilisation, and…

8 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
a1c
a1c

Glycated haemoglobin as a ninety-day glycaemic average: what a change of half a point means, why it lags, and the conditions under which it…

122 questions
asked by ahmed_zerouali 15k · 23 months ago
20 votes 3 answers7.2k views
Why do the A1c reductions in SURPASS look so much bigger than in the obesity trials?

I have been reading across the programmes and the A1c numbers do not line up in any way I can make sense of. SURPASS-2 reports tirzepatide lowering A1c by more than 2…

a1c
a1c

Glycated haemoglobin as a ninety-day glycaemic average: what a change of half a point means, why it lags, and the conditions under which it…

122 questions
clinical-trials
clinical-trials

Reading the primary literature properly: estimands, intention-to-treat versus per-protocol, confidence intervals, absolute versus relative…

745 questions
tirzepatide
tirzepatide

A dual GIP and GLP-1 receptor agonist. Questions here cover the SURPASS and SURMOUNT programmes, the practical differences from a pure GLP-1…

370 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
asked by sample_id 17k · 5 months ago
19 votes 4 answers3.4k views
What does a payer want to see before approving liraglutide?

I have the plan documents and the written criteria, which took two calls to obtain. I want a method I can write down and repeat, not a rule of thumb. I would rather…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
liraglutide
liraglutide

A once-daily GLP-1 receptor agonist and the compound that established the class. Still relevant for its shorter half-life, its paediatric and…

235 questions
asked by mg_per_ml 15k · 3 months ago
15 votes 5 answers6k views
What does a payer want to see before approving cagrilintide?

I have been through one internal appeal already and would like to do the next one properly. I can find plenty of assertions about this and almost no reasoning, which…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
amylin
amylin

Amylin and its analogues, most prominently cagrilintide, as a satiety mechanism orthogonal to incretin signalling. Includes the pharmacology of…

237 questions
asked by e_dziedzic 51k · 5 months ago
13 votes3 answers8.8k views
How does step therapy change if the indication is T2DM rather than obesity?

I have an A1c of 6.9% on metformin alone, a BMI of 34, hypertension, and a family history of premature cardiovascular disease. My plan covers GLP-1 receptor agonists…

insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
asked by pk_curve 30k · 13 months ago
13 votes4 answers7.3k views
What does a payer want to see before approving survodutide?

The pharmacy is accredited and I have verified that on the accreditor register. I am trying to do this correctly the first time rather than learn it by getting it…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
survodutide
survodutide

A GLP-1 and glucagon receptor dual agonist with a substantial published MASH dataset. Use this tag for its hepatic endpoints, its dose ladder, and…

225 questions
asked by priya_menon 13k · 6 months ago
12 votes 5 answers22k views
What does a payer want to see before approving mazdutide?

I have the plan documents and the written criteria, which took two calls to obtain. I can find plenty of assertions about this and almost no reasoning, which is…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
mazdutide
mazdutide

A GLP-1 and glucagon receptor dual agonist developed primarily in China, with a distinct dose range and a fast-moving publication record.…

237 questions
asked by sample_id 17k · 14 months ago
12 votes 5 answers12k views
What does a payer want to see before approving retatrutide?

This is a United States plan; I appreciate the answer is jurisdiction-specific. Everything I have found on this is either a forum aside or a product page, neither of…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
retatrutide
retatrutide

An investigational GLP-1, GIP and glucagon receptor tri-agonist, studied in the TRIUMPH programme. Not approved anywhere. Use this tag for…

251 questions
asked by anouk_desmet 16k · 10 months ago
11 votes 3 answers12k views
What does a payer want to see before approving tirzepatide?

I have been through one internal appeal already and would like to do the next one properly. I want a method I can write down and repeat, not a rule of thumb. I would…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
tirzepatide
tirzepatide

A dual GIP and GLP-1 receptor agonist. Questions here cover the SURPASS and SURMOUNT programmes, the practical differences from a pure GLP-1…

370 questions
asked by Dr_Sara_Kuusela 28k · 10 months ago
10 votes5 answers6.6k views
What does a payer want to see before approving a GLP-1 receptor agonist?

I have the plan documents and the written criteria, which took two calls to obtain. I can find plenty of assertions about this and almost no reasoning, which is…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
asked by helena_vidmar 8.5k · 4 months ago
8 votes 5 answers26k views
What does a payer want to see before approving semaglutide?

This is a United States plan; I appreciate the answer is jurisdiction-specific. I am trying to do this correctly the first time rather than learn it by getting it…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
semaglutide
semaglutide

A GLP-1 receptor agonist with a fatty-acid-acylated backbone and a roughly one-week half-life, marketed for type 2 diabetes and for weight…

470 questions
asked by Dr_Elias_Weiss 25k · 22 months ago
8 votes5 answers11k views
Does treatment change insulin requirements in type 2 diabetes?

The clinician who ordered the panel was not concerned; I would still like to understand it. The empirical answer seems settled. The explanation does not. If the…

t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
a1c
a1c

Glycated haemoglobin as a ninety-day glycaemic average: what a change of half a point means, why it lags, and the conditions under which it…

122 questions
bloodwork
bloodwork

Laboratory monitoring: which panels are worth ordering, sensible intervals, reference-range versus optimal-range arguments, and how to read a…

296 questions
asked by second_lot 9.4k · 5 months ago
5 votes0 answers5.2k views
Is insulin resistance the mediator in PCOS, or is it the weight loss?

My laboratory results are from the same laboratory each time, drawn fasting, which I gather matters. This is one of those things that everyone repeats and nobody…

pcos
pcos

Polycystic ovary syndrome: insulin resistance as the shared mechanism, ovulatory and menstrual outcomes reported on treatment, androgen changes,…

9 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
hormones
hormones

Endocrine changes accompanying substantial weight loss: sex hormone binding globulin, testosterone, oestradiol, cortisol and the reproductive…

13 questions
asked by thabo_maseko 28k · 23 months ago
1 vote3 answers1.5k views
What does a payer actually need to see in a prior-authorisation request?

I would like to understand the process rather than be told to try harder. I am trying to do this correctly the first time rather than learn it by getting it wrong. I…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
asked by Dr_Ravi_Selvarajah 35k · 2 months ago
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