Rationale of the Week | Best advice on adding new med, Mounjaro

For last week’s practice question, we quizzed test takers on Mounjaro, a new medication. 82% of respondents chose the best answer. We want to 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 Question

Question: The FDA recently approved the new ‘twincretin” dual incretin hormone therapy called Tirzepatide (Mounjaro).  The provider wants to start a person with type 2 diabetes on this new medication and asks for your consultation.  The person’s current medications for type 2 diabetes include metformin, empagliflozin (Jardiance), semaglutide (Ozempic), and Pravachol.  What is the best response to the provider?

Answer Choices:

  1. Inform provider that Tirzepatide (Mounjaro) is contraindicated in people taking SGLT-2 Inhibitors.
  2. Recommend stopping the semaglutide (Ozempic) before starting the Tirzepatide (Mounjaro).
  3. Reinforce the importance of prescribing a CGM before starting Tirzepatide (Mounjaro).
  4. Request provider also prescribes Glucagon rescue med in case of severe hypoglycemia.

As shown above, the most common choice was option 2, the second most common answer was option 4, then option 1, and finally 3.

Getting to the Best Answer

Answer 1 is incorrect. 6.53% chose this answer, “Inform provider that Tirzepatide (Mounjaro) is contraindicated in people taking SGLT-2 Inhibitors.” According to the Package Insert, Tirzepatide can be used in combination with SGLT-2 Inhibitors and other approved diabetes medications. However, since Tirzepatide is a combination of GLP-1 and GIP Incretins, it is not recommended to use in combination with a GLP-1 RA or the DPP-IV class of medications. Read more on our blog here.

Answer 2 is correct. 82.13% of you chose this answer, “Recommend stopping the semaglutide (Ozempic) before starting the Tirzepatide (Mounjaro).” YES, GREAT JOB! Since Tirzepatide is a combination of GLP-1 and GIP Incretins, it is not recommended to use in combination with a GLP-1 RA or the DPP-IV class of medications.

Answer 3 is incorrect. 4.12% of respondents chose this answer, “Reinforce the importance of prescribing a CGM before starting Tirzepatide (Mounjaro).” Since this person is not on insulin or any medications that would cause low blood sugar, a CGM is not required to monitor blood sugars. Blood glucose monitoring combined with regular A1C testing will be important to determine the efficacy of this new “twincretin”. Read more on our blog here.

Finally, Answer 4 is incorrect. 7.22% chose this answer, “Request provider also prescribes Glucagon rescue med in case of severe hypoglycemia.” Since this person is not on insulin or any medications that would cause low blood sugar, a glucagon rescue med is not required to treat severe hypoglycemia. Blood glucose monitoring combined with regular A1C testing will be important to determine the efficacy of this new “twincretin”. Read more on our blog here.


Want to learn more about this question?

New Dual Incretin Injectable – “TwinCretin”

The FDA just approved a novel, dual incretin hormone therapy called Tirzepatide (Mounjaro).

This new twin incretin injectable 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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