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Published September 27, 2023

Starting tirzepatide at the lower end of the equivalent dose range and titrating up is recommended to improve tolerability

Comorbidities such as cardiovascular disease, sleep apnea, or uncontrolled diabetes change priorities: reduce hypoglycemia risk, avoid volume depletion, and maintain glycemic targets that fit the procedures risk profile

The current understanding points to a potential biphasic pattern in GLP-1 RA studies, where any observed early worsening may be related to rapid glycemic improvement rather than direct retinal toxicity, particularly in patients with pre-existing retinopathy, poor glycemic control, and those undergoing HbA1c reduction 47