Management of Hypoglycemia Using Continuous Glucose Monitoring During Tirzepatide Initiation or Uptitration When Used in Addition to Other Glucose-Lowering Agents

The use of injectable incretin-based therapies is becoming more common. Diabetes and obesity are prevalent disease states that can lead to mortality and further health complications. Tirzepatide is a glucose-dependent insulinotropic polypeptide (GIP)/glucagon-like peptide 1 (GLP-1) receptor agonist used in the management of type 2 diabetes, obesity, and overweight (with at least one weight-related complication). Tirzepatide selectively binds to and activates both the GIP and GLP-1 receptors, which are the targets for native GIP and GLP-1. Tirzepatide enhances first- and second-phase insulin secretion and reduces glucagon levels in a glucose-dependent manner ( 1 ). The mechanism of dual agonism results in reductions in blood glucose and body weight. Administered as a once-weekly subcutaneous injection, tirzepatide was approved by the U.S. Food and Drug Administration in May 2022 for the management of type 2 diabetes, in November 2023 for weight management in adults with obesity (BMI >30 kg/m 2 ) or overweight (BMI >27 kg/m 2 ) with at least one weight-related condition, and in December 2024 for the treatment of obstructive sleep apnea (OSA) ( 2, 3 ).