Marcia Virginia Nunes Rodrigues

CPF: 308.821.684-87 Data e hora: 09/01/2023 - 15:32:01 (GMT-3)

Medical report

The aforementioned patient has been under regular medical follow-up with me since November/2022.

He currently has the following diagnoses;

- hashimoto hypothyroidism
- Parkinson's disease
- obesity II (weight 100.65kg BMI: 36.73)
- zinc deficiency
- vitamin c deficiency
- DHEA deficiency
- menopause
In requested laboratory tests, he presented the following results, even using metformin 1g/day.
- HbA1c 5.8 Sdhea 82 Insulin 16 glucose 95
According to the studies done with the drug in question (Mounjaro) we have the following in summary:
01. Tirzepatida increases the sensitivity of pancreatic ;" 6VÆÇ2 Fò vÇV6÷6Râ —B –× &÷fW2 F†R f—'7B æB 6V6öæB † 6W2
glucose-dependent insulin secretion.
In a hyperglycaemic clamp study in patients with type 2 diabetes, tirzepatide was compared with placebo and the
selective GLP-1 receptor agonist semaglutide 1 mg with respect to insulin secretion. Tirzepatide 15 mg improved the
rate of the first and second phases of insulin secretion by 466% and 302% compared to baseline, respectively. There
was no change in the rate of the first and second phases of insulin secretion with placebo.
02. Tirzepatida increases insulin sensitivity.
Tirzepatide 15 mg improved the body's insulin sensitivity by 63% as measured by the M-value, a measure of tissue
glucose uptake using a hyperinsulinemic euglycemic clamp. The M-value did not change with placebo.

03. Tirzepatida decreases body weight in patients with type 2 diabetes, which may contribute to improved insulin
sensitivity. Reducing food intake with tirzepatide contributes to body weight loss. The reduction in body weight is
mainly due to the reduction in fat mass.
04. Tirzepatide reduced fasting and postprandial glucagon concentrations in a glucose-dependent manner. Tirzepatide
15 mg reduced fasting glucagon concentration by 28% and glucagon AUC after a mixed meal by 43% compared with
no change with placebo.
05. Tirzepatida delays gastric emptying, which may slow down glucose absorption after a meal and may lead to a
beneficial effect on postprandial glycemia. The delay in gastric emptying induced by tirzepatide decreases over time.
Regarding the drug being used in monotherapy, we have the following;
SURPASS 1 – Monotherapy
In a 40-week, double-blind, placebo-controlled study, 478 patients with inadequate glycemic control with diet and
exercise were randomized to receive tirzepatide 5 mg, 10 mg, or 15 mg once weekly or to receive placebo. The patients
had an average age of

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Marcia Virginia Nunes Rodrigues
CPF: 308.821.684-87 Data e hora: 09/01/2023 - 15:32:01 (GMT-3)

54 years old and 52% were men. Initially, patients had an average duration of diabetes of
5 years and the average BMI (body mass index) was 32 kg/m2.
Furthermore, we know that the percentage of patients achieving HbA1c < 5.7% without hypoglycemia was clinically
significant in 4 studies. In them, tirzepatide was not combined with basal insulin, 93.6% to 100% of patients achieved a
normal blood glucose of HbA1c < 5.7% ("d 39 mmol/mol) at the primary endpoint visit with treatment with tirzepatida
had no clinically significant hypoglycaemia. In SURPASS Study 5, 85.9% of patients treated with tirzepatide who
achieved HbA1c < 5.7% ("d 39 mmol/mol) did not have clinically significant hypoglycaemia.
We know that patients diagnosed with Obesity have a high cardiovascular risk and rapid evolution to metabolic
syndrome, therefore, the patient in question would indeed benefit from the use of the medication, since they include:
In patients using tirzepatide, in addition to weight loss, a number of other benefits were observed, for example:
- Improves blood pressure levels;
- Reduction of triglyceride indices;
- Increased HDL cholesterol (good cholesterol);
- Drop in LDL cholesterol (bad cholesterol);
- Reduction of insulin levels;
- Remission of prediabetes in more than 95% of patients with prediabetes before treatment;
Improvement in body composition with a reduction in fat mass three times greater than muscle mass.
In this way, these health improvements can lead to a reduced risk of developing a number of diseases:
- Cardiovascular problems;
- Chronic kidney disease;
- Non-alcoholic steatohepatitis (NASH);
available
Dr. Priscilla Machado Arruda

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