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B., Grevink, R

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For others, their system may need a more regular top-up to maintain optimal levels

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You'll need prior authorization, which typically requires BMI 30 (or 27 with comorbidities), 6 months of documented lifestyle efforts, and possibly step therapy

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10.1016/0009-8981(85)90020-8 Sugimoto T, Muro H, Woo M, Nishida N, Murakami K: Valproate metabolites in high-dose valproate plus phenytoin therapy

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This could make oral semaglutide more accessible, though its important to remember that orforglipron is not yet commercially available

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The people who deserve extra attention usually include: Patients with a known history of diabetic retinopathy Patients with diabetic macular edema Patients with recently worsening retinopathy Patients with poor baseline glucose control who may experience a large A1c drop Patients starting semaglutide while already under retina treatment Patients with multiple high-risk features such as kidney disease, hypertension, or long-standing diabetes In contrast, a patient with type 2 diabetes, no known retinopathy, and a recent normal dilated exam may still need routine follow-upbut often not the same level of concern as someone with active retinal disease

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