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My Approach When Prescribing Here's my general framework not a rigid protocol, but a starting point for the conversation: I Tend to Start with Semaglutide When The patient has established cardiovascular disease (because of the SELECT trial data) Insurance covers semaglutide but not tirzepatide The patient has MASH/fatty liver disease Cost is the primary concern and semaglutide is more accessible I Tend to Start with Tirzepatide When Maximum weight loss is the primary goal The patient has type 2 diabetes (tirzepatide shows greater A1C reduction roughly 2.02.5% vs 1.02.0% for semaglutide) The patient has tried semaglutide with insufficient results Insurance covers both options equally Regardless of which medication we choose, I always emphasize that GLP-1 therapy is most effective when combined with nutritional counseling, physical activity, and behavioral support

However, Cpt1a-deficient cells exhibit increased glucose dependency that enables survival and eventual tumor progression

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Leptin deficiency induced by fasting impairs the satiety response to cholecystokinin

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