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Regarding adverse events, one thing stands out is dysesthesia which occurred in 8.8% and 20.9% (9 mg and 12 mg, respectively) of patients, compared to 0.7% with placebo

Starting a GLP-1 without addressing hormonal optimization is leaving a major piece of the puzzle on the table for most active patients.

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The authors explicitly suggest reframing switching as part of long-term optimization rather than discontinuation

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Individualization is Key: The ADA strongly advocates tailoring HbA1c goals based on: Duration of diabetes Risk of hypoglycemia Life expectancy Comorbidities (cardiovascular disease, CKD) Patient preference and treatment burden Beyond HbA1c: Modern diabetes care increasingly integrates Continuous Glucose Monitoring (CGM) metrics such as Time in Range (TIR) alongside HbA1c