Barlowe TS, Anderson C, Sandler RS, Subramaniam D, Muratore A, Buse JB, et al
Startups have the chance to lead in delivering comprehensive, evidence-based weight care at scale
What about future retatrutide pricing in 2026 and beyond
Even with these cost reductions, accessibility remains a concern

Drugs/ Drug Classes Metformin TZDs, alogliptin SGLT2 inhibitors Canagliflozin (hyperkalemia), insulin (hypokalemia) DPP4-inhibitors, GLP-1 agonists (not studied in GLP-1/GIP RA) DPP4 inhibitors, SUs SGLT2-inhibitors Pioglitazone, dapagliflozin (bladder cancer) GLP-1 agonists (thyroid cancer) Major Risks Lactic acidosis Hepatotoxicity hypotension/dehydration, UTI/genital infections K abnormalities Pancreatitis Hypersensitivity reactions Ketoacidosis Cancer Intervention %A1C Advantages Insulin No limit dose, low $, Sulfonylureas Disadvantages microvascular Injections, stigma, monitoring, hypoglycemia, weight gain, analogs high $ Low $, experience, microvascular Weight gain, hypoglycemia, limited efficacy TZDs No lows, improves lipid profile, maybe lower MI risk Fluid retention, CHF, weight gain, bone fractures, bladder CA GLP-1 RA, GLP-1/GIP RA Weight loss, no lows, DPP-4 Inhibitors Weight neutral, no lows, well tolerated Less experience, urticaria, angioedema, pancreatitis, high $ Meglitinides Dosing flexibility, post prandial glucose TID, hypoglycemia, weight gain, high $ Weight neutral, post prandial glucose GI SE, TID, moderate $ may B- cell function -glucosidase inhibitors Injections, GI SE, high $, less experience, thyroid tumors question Combination Products Metformin + SU Metformin/glipizide Meformin + Meglitinide Metformin/repaglinide (PrandiMet) Metformin +TZD Metformin/pioglitazone (Actoplus Met, Actoplus Met XR) Metformin/rosiglitazone SU+TZD Glimepiride/pioglitazone (Duetact) Glimepiride/rosiglitazone Metformin+ DPP4 Inhibitor Metfromin/alogluiptin (Kazano) Metformin/linagliptin (Jentadueto, (JentaduetoXR) Metformin/sitagliptin (Janumet, Janumet XR) Metfromin/saxagliptin (Kombiglyze XR) DPP4 Inhibitor + TZD Alogliptin/pioglitazone (Oseni) Metformin + SGLT2 Inhibitor Metformin/canagliflozin (Invokament, Invokamet XR) Metformin/dapagliflozin (Xigduo XR) Metformin/empagliflozin (Synjardy, Synjardy XR) DPP4 Inhibitor + SGLT 2 Inhibitor Linagliptin/empagliflozin (Glyxambi) Saxagliptin/dapagliflozin (Qtern) GLP1 Agonist + Long Acting Insulin * Liraglutide/insulin degludec ( Xultophy) Lixisenatide/insluin glragine (Soliqua) * Newest combinatuion produts engine hype 2Gt kidney Day 3 Mini Review FDA approved CVD benefit FDA approved HF benefit FDA approved CKD benefit Glucose-Lowering Effect- Very High, High, Intermediate Weight-loss Efficacy- Very High, High, Intermediate What new drug(s) did ADA 2023/2024 add for DM

The synergistic enhancement theory proposes that GIP and GLP-1 dont just add to each other but actually amplify each others effects