Pre-Prescription Evaluation for Tirzepatida in Adult Patients with Type 2 Diabetes

Essential Laboratory Tests

The American Diabetes Association recommends measuring hemoglobin A1c (HbA1c) at least twice a year if targets are being met, or quarterly if therapy has been altered or targets are not being achieved, in adult patients with type 2 diabetes 1, 2, 3
The American Diabetes Association suggests that serum creatinine and estimated glomerular filtration rate (eGFR) are essential for assessing baseline renal function in adult patients with type 2 diabetes 1, 4, 5
The American Diabetes Association recommends that the urine albumin-to-creatinine ratio be performed annually in all patients with type 2 diabetes at the time of diagnosis 1, 4
Patients with an eGFR <30 mL/min/1.73 m² may benefit preferentially from GLP-1 receptor agonists (including tirzepatida) rather than SGLT-2 inhibitors, according to the American Diabetes Association 6

The American Diabetes Association recommends a comprehensive dilated eye examination for patients with type 2 diabetes shortly after diagnosis 1, 5
The American Diabetes Association suggests that blood pressure be determined at each visit in adult patients with type 2 diabetes 1, 3
The American Diabetes Association recommends an electrocardiogram in adults if clinically indicated 2

The American Diabetes Association recommends adjusting concomitant medications, such as insulin or sulfonylureas, to minimize the risk of hypoglycemia before initiating tirzepatida 6
The American Diabetes Association suggests that tirzepatida not be used concomitantly with DPP-4 inhibitors, as this does not provide additional glucose reduction 6

The American Diabetes Association recommends not delaying modification of treatment for adults who are not meeting individualized treatment targets 6
The American Diabetes Association suggests monitoring serum creatinine and potassium levels when using ACE inhibitors, BRAs, or diuretics 1

The American Diabetes Association recommends not relying solely on HbA1c in conditions with increased red blood cell turnover, such as sickle cell disease, pregnancy, hemodialysis, recent blood loss/transfusion, or erythropoietin therapy, and instead using plasma glucose criteria 7

The guideline society recommends reducing insulin dosing when adding tirzepatide to existing insulin therapy to minimize hypoglycemia risk, although the exact reduction is not specified 7