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It depends on the individual case
This is the moment when a conversation with a bariatric surgeon often becomes the most practical next step
Combining with DPP-4 inhibitors is generally not recommended, as both drug classes work on the incretin system Adding basal insulin for those with more significant hyperglycaemia, which can be used alongside GLP-1 medications (with careful monitoring for hypoglycaemia) Switching to insulin therapy entirely may be necessary for those with advanced beta cell failure For weight management , when GLP-1 medications don't produce adequate weight loss, alternatives include: Orlistat , a lipase inhibitor that reduces fat absorption, though weight loss is typically modest (2-3 kg on average) Naltrexone-bupropion (Mysimba), which works on appetite centres through different pathways
Discuss benefits and risks with your provider before starting treatment
A second, more recent analysis (Lee and Kim, DMRR 2026) found no significant signal for tirzepatide once it had been statistically adjusted
