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The pattern is predictable

The addition of GIP receptor agonism in tirzepatide does not appear to significantly amplify heart rate effects compared to GLP-1-only drugs like semaglutide

Most patients should receive metformin initially, but if control is suboptimal after 36 months, treatment intensification with another glucose-lowering therapy is required, and selection of subsequent therapies should be made on an individualized basis to meet the specific needs of the patient (4)