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DElia E, Vaduganathan M, Gori M, Gavazzi A, Butler J, Senni M (2015) Role of biomarkers in cardiac structure phenotyping in heart failure with preserved ejection fraction: critical appraisal and practical use

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If GI AEs are present, then the authors recommend a more cautious approach, with slower uptitration (every 48 weeks)

GLP-1 + GIP + Glucagon Receptor Activation All benefits of GLP-1 activation (appetite, fullness, insulin) GIP enhances insulin response and may reduce GLP-1 side effects Glucagon increases thermogenesis and energy expenditure Combined effect exceeds sum of individual pathways The idea of using glucagon for weight loss was considered counterintuitive until researchers discovered that glucagons metabolic effects depend heavily on the hormonal context

Finally, if broad GLP-1 coverage is not feasible, prioritizing coverage for individuals with high severity (BMI over 40) or those with comorbidities and risk factors can be a practical starting point