Earlier GLP-1 Use in Type 2 Diabetes: What Are We Waiting For?
Why the Traditional Stepwise Approach May be Leaving Your Patients Exposed to Preventable Complications
In this video:
✔ The patient on maximum metformin who still can’t get to goal — and what the GLP-1 trial data says about that exact clinical scenario
✔ The gap between when ADA guidelines say to consider GLP-1 therapy and when the evidence says your patient is already at risk
✔ The conditions accumulating silently in your T2D patients that won’t present symptoms until they’re advanced
✔ How to reframe GLP-1 therapy in patient conversations – from late-stage rescue to early, proactive strategy
The Hidden Cost of "Wait and See"
The overweight patient, recently diagnosed, on maximum metformin, with an A1C between 7.8 and 8.12%. You’ve seen this patient. You’ll probably see one this week.
What you may not see are the conditions already developing – cardiovascular risk, early kidney function decline – that won’t present with symptoms until they’re advanced. By the time GLP-1 therapy enters the picture for most of these patients, the window for prevention has narrowed considerably and the focus shifts to delaying the progression of possible complications.
In this discussion, Dr. Steve Edelman and Dr. Schafer Boeder challenge the conventional treatment timeline and make the case for rethinking when, not if, GLP-1 agents should be part of your approach
Meet Your Ultra-Experts
*extra-relatable faculty (he's living with type 1!)
Founder & Director, TCOYD; Endocrinologist, Clinical Professor of Medicine, University of California, San Diego (UCSD) School of Medicine; Director, Diabetes Care Clinic, VA Medical Center San Diego
Endocrinologist, Founder & Director TCOYD; Professor of Medicine, UCSD School of Medicine, VA Medical Center, San Diego, California
Endocrinologist, Co-Director of TCOYD, Assistant Professor of Medicine, UCSD School of Medicine, San Diego, California
Endocrinologist, Co-Director of TCOYD; Medical Director and Principal Investigator, Paradigm Clinical Research; Associate Professor of Medicine, UCSD School of Medicine, San Diego, California
BMI
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Cardiovascular risk
Would it be safe for someone with Type 1 to use GL1Ps?
Absolutely. Most endocrinologists I work with prescribe them routinely, if there is a weight issue, evidence of cardiovascular renal disease, and/or sleep apnea, which could help you get it approved from insurance. Use a prior auth and ask for Wegovy or Zepbound – don’t mention diabetes in the prior auth.
Protection for kidneys within the high range of pre-diabetes.
Not sure A1c probably
what if you are not overweight
Generally speaking, you can start with a low dose, and you can find the right dose that you can tolerate but also does not lead to significant weight loss. But obviously work with your own doctor on the best plan and strategy for you.