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Metformin should be initiated unless (1) contraindications exist, (2) the A1C level indicates the need for insulin (at which time both insulin and metformin could be started), or (3) the A1C level is very close to goal (within 0.5% of goal) at the time of diagnosis and the patient is motivated to make appropriate lifestyle interventions
Some patients respond exceptionally well to Ozempic and achieve meaningful weight loss without needing a medication switch
Clinical studies have shown that patients using tirzepatide achieved significant weight loss compared to those using a placebo
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