B., Grevink, R
For others, their system may need a more regular top-up to maintain optimal levels
You'll need prior authorization, which typically requires BMI 30 (or 27 with comorbidities), 6 months of documented lifestyle efforts, and possibly step therapy
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
This could make oral semaglutide more accessible, though its important to remember that orforglipron is not yet commercially available
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