Q1. Please describe your specialty and details about your practice

How many Type 2 diabetes patients do you treat

Please describe the standard of care in the treatment of Type 2 Diabetes.
Which drugs are used and in which order, and what are the preferred agents?
Where do GLP-1 agonists fit into this picture?
What drives the decision when choosing between different GLP-1 agonists, and what is the preferred formulation of semaglutide (Ozempic/Rybelsus) among the subQ and oral options?

Do you anticipate an evolution in the standard of care where guidelines will recommend GLP-1 agonists first line and the field will move away from Metformin as a first line treatment?

How might this affect prescribing among specialists?
How might this affect prescribing in the primary care setting?
Do you intend to use GLP-1's more as a first line option?

How has the reimbursement situation been with GLP-1 prescribing, and what kind of challenges might Tirzepatide face entering this marketplace? 

Where would you want to see Tirzepatide priced and what pricing would make it most competitive and most able to gain share in this market? 

Given that Tirzepatid is a dual agonist of GIP and GLP-1, in terms of the biology/physiology are there known benefits from GIP agonism that you expect are contributing to efficacy with this product?   

Will this contribute to long term cardiovascular benefit in the ongoing CVOTs or could it mitigate to some degree the benefits from GLP-1 agonism which are already established?

What is your high level view of Tirzepatide safety and efficacy from its "SURPASS" phase 3 trials, and do you expect it to be approved at its approaching PDUFA date in May?  

Is the efficacy differentiated, and would this become your preferred agent?

In the SURPASS 2 Trial comparing multiple doses of Tirzepatide to Semaglutide 1mg, do you find the superiority on A1c, weight reduction, and blood pressure convincing?
Was Semaglutide dosed suboptimally in the trial and therefore the superiority is in doubt, or does the totality of data suggest Tirzepatide is reaching a new level of efficacy in the space not seen before?

27-46% on Tirzepatide reached <5.7% A1c, vs 19% on semaglutide.
With same caveat above on optimal dosing, is this a convincing difference?
This is described in NEJM as "without increasing hypoglycemia" but 1.7% at the highest dose (15mg) Tirzepatide experienced hypoglycemia.  Is this concerning or acceptable?

On obesity, could you talk about the overlap with diabetes patients and is this something you also treat separately from diabetes?  If so, what are the main things you prescribe for obesity, with or without diabetes, and what kind of success do you see with them?
Have you prescribed Wegovy?

In the Phase 3 trial of semaglutide/wegovy, mean bodyweight reduction was 14.9%, at week 68. How do you view this result?
In the recently announced phase 3 trial of Tirzepatide at week 72, mean bodyweight reduction was 16% at 5mg dose, 21.4% at 10mg dose, and 22.5% at 15mg dose.
This seems amazing to me, what is your view?  And how do you compare these two agents?   
Is this simply a superior weight loss drug vs. Wegovy?  
Are there any side effect concerns using the 10 and 15 mg doses? 

Has Wegovy been difficult to get to patients due to payor resistance to the price and lack of outcomes data (beyond weight loss) produced yet for this agent?
Will another agent like Tirzepatide, possibly even better, entering the market change this dynamic?  Or will it just be more of the same? 
What are the factors that will lead to broad prescribing of GLP-1 weight loss drugs, and what needs to change in your view to get to that point?

What has patient experience been like with Wegovy so far for those you've prescribed it to?

What's your level of excitement about Tirzepatide for Diabetes treatment on a scale of 1-10?

If prescribing of weight loss drugs with this level of efficacy becomes more common, how will this impact the disease landscape?   Will Diabetes and other ailments be prevented to a large degree?  A small degree?  

What happens when patients discontinue these drugs?
Does their weight shoot right back up?
Do you view glp-1s as a lifelong intervention?  Any safety concerns with that?