Rationale of the Week | Best action before starting tirzepatide (Mounjaro)?

For last week’s practice question, we quizzed test takers on the best action before starting Tirzepatide (Mounjaro). 67% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Q uestion

Question:

AR is 36 years old with type 2 diabetes and a BMI of over 40. Current A1C 7.9%, UACR less than 30, and GFR more than 60. Current diabetes medications include metformin, sitagliptin, and empagliflozin at maximum doses. AR is prescribed the new dual incretin tirzepatide (Mounjaro) to help improve glucose levels and support weight loss.

Before starting tirzepatide (Mounjaro), what action do you recommend to the provider?

Answer Choices:

Repeat the UACR and GFR to verify kidney function.
Stop the sitagliptin.
Decrease metformin dose to prevent hypoglycemia.
Evaluate thyroid function.

Getting to the Best Answer

Answer 1 is incorrect. 11.31% chose this answer, “Repeat the UACR and GFR to verify kidney function.” This is not the best answer because JR has great kidney function, evidenced by a normal UACR and GFR. So we do not need to recheck kidney function before starting this new dual incretin tirzepatide (Mounjaro).

Answer 2 is correct. 67.43% of you chose this answer, “Stop the sitagliptin.” YES, this is the best answer. The American Diabetes Association (ADA) and American Association of Clinical Endocrinologists recommend against combination therapy with a DPP4-inhibitor and a GLP-1 RA due to the lack of evidence that this strategy is beneficial. Initial research combining the two classes, reflect a negligible glucose lowering effect when GLP-1’s and DPP-4’s are combined. Given the approximate average wholesale price for the DPP-4 inhibitor of $434 and GLP-1 RA of $887, using both simultaneously is not cost effective or clinically beneficial.

Answer 3 is incorrect. 4.4.% of respondents chose this answer, “Decrease metformin dose to prevent hypoglycemia.” No need to decrease the metformin dose, since JR is not on any medication class that will cause hypoglycemia.

Finally, Answer 4 is incorrect. 16.82% chose this answer, “Evaluate thyroid function.” This class of medication is not recommended for any person with a history of medullary thyroid tumor. However, we don’t need to draw a TSH to see if this medication is safe, we would simply do a careful history to see if there is a family history of medullary thyroid tumor.

Thank you so much for reading this “Rationale of the Week”. You can download our Medication PocketCard below, for more information.

New Injectable – “TwinCretin” on Printed PocketCards

We have just added this novel, first in class, dual incretin hormone therapy, Tirzepatide (Mounjaro), to our printed version of our Diabetes Medication PocketCard.

This new twin therapy includes not only a GLP-1 Receptor Agonist, but also a Glucose-dependent insulinotropic polypeptide (GIP), which magnifies the therapeutic effectiveness. The SURPASS studies indicate that study participants experienced an A1C drop of up to 2.5% and weight loss of up to 10kg or more.

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Virtual DiabetesEd Training Conference | 30+ CEs

Airs October 12-14th, 2022

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Join us LIVE for this Virtual Training Conference and enjoy a sense of community!

Whether you are new to diabetes or a seasoned expert, you’ll benefit from this virtual conference with the latest research plus critical content that you can immediately apply to your clinical practice.

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If you are seeking a state-of-the-art review of current diabetes care, this course is for you. Our team has been fine-tuning this course for over fifteen years, and we know what you need. This program can also be a great addition to your CDCES or BC-ADM exam study plan.

Team of expert faculty includes:

Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator

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New Tubeless Insulin Delivery System Approved for Toddlers

The FDA just authorized the Insulet Omnipod 5 tubeless insulin delivery system for pediatrics with type 1 diabetes starting as young as age 2. This remarkable moment marks the availability of the world’s first tubeless, wearable insulin delivery system for toddlers.

The Omnipod 5 received FDA approval earlier this year for integration with the Dexcom G6 continuous glucose monitor for adults and kids with type 1, but Insulet also petitioned the FDA to approve this technology for toddlers.

First Tubeless Hybrid Closed Loop System

This first tubeless hybrid closed loop system to receive FDA authorization includes the Omnipod 5, Dexcom G6 CGM and a phone app or controller to manage insulin delivery and monitor glucose levels. The Omnipod holds three days worth of insulin in a pod delivery device without the need for tubing, which can be helpful for active toddlers. No calibration or fingersticks are required.

As a hybrid loop system, the Omnipod and Dexcom are continuously data sharing, so most of the insulin delivery is automated. However, users can make needed adjustments, deliver bolus insulin and easily share data with the smartphone app or Ominpod 5 Controller.

Promising Outcome Data

Based on a study presented at the annual ADA Scientific Session, children with type 1 diabetes experienced a drop in A1C levels from a baseline of 7.4% to 6.9% and they remained at this improved A1C level for one year into the study. Time in range also increased from 57% at baseline to 68% after using the Omnipod 5 for three months. In addition, there were no reported cases of DKA or severe hypoglycemia. For more information on the latest in insulin pumps and CGMs, please join our Virtual Conference with technology expert Diana Issacs. In addition to explaining the technology, she provides an awesome “show and tell”.

Lila Grace Moss wears Omnipod on Runway

On a related note, I would like to give recognition to the courageous Lila Grace Moss, who lives with type 1 diabetes. On a recent runway show, she did not shy away from wearing her Omnipod as she modeled the latest fashion styles with camera’s clicking and hundreds of audience members.

Social media took note and many instagram followers thanked Lila for her bold and brave statement.

Thanks Lila!

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