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Decision factors: Weight loss goals: Want maximum weight loss and can tolerate side effects: Tirzepatide (Zepbound) shows ~4% greater weight loss than semaglutide on average Want proven cardiovascular benefits: Semaglutide has demonstrated 20% reduction in major cardiovascular events in the SELECT trial Want to try oral option: Oral semaglutide (Rybelsus) for diabetes, though weight loss is less than injectable Side effect sensitivity: Some people tolerate one better than the other

Vitamin and nutrition deficiencies are common

Diabetes Ther (2021) 12:267790

Significant upper right abdominal pain after eating Particularly if accompanied by nausea, may indicate gallbladder problems

Baseline glycemic control : Patients with higher HbA1c levels may require more aggressive dose escalation, though this must be balanced against tolerability