Mounjaro for Patients with T2DM in Primary care

Mounjaro for Patients with T2DM in Primary care 

Alistair Kumi, First Contact Dietitian in Diabetes 

Emmer Green Surgery / Primary Care Dietitians 

Overview 

• We had 28 diabetes patients on Mounjaro who met eligibility criteria 

• We had 16 who were started on Mounjaro in May 2024 (when the guidance in our ICB changed April 2024) 

• 12 of the 16 were successful in coming back to complete a weight and Hba1c within the first 3 months   

• They were all advised we would be conducting a 6-month trial, and they would need to achieve at least:  
  - 3% weight loss  
  - 11mmol/mol drop in Hba1c or maintenance of Hba1c <48mmol/mol 

• Patients were also advised that the aim would be sustain a healthy weight without Mounjaro in 2 years (so we prep patients mentally for weaning off) 

• They were also advised that we would be doing monthly optimisation and were given dietary advice/support at each monthly review before assessing need to increase the dose  

• We conducted an assessment before starting patients and were very strict about exclusion criteria 

• We did a 30-minute weekly MDT to assess new starts, review existing Mounjaro users, address adverse effects swiftly and offer alternatives 

Eligibility Criteria 

• BMI >35 

• Aged 18+ 

• Previous Trulicity users affected by the prescription shortage 

• BMI of 35 kg/m2 or more, and specific psychological or other medical problems associated with obesity (i.e. those awaiting orthopaedic surgery, sleep apnoea sufferers, increasing insulin resistance and needing addition therapies) 

Exclusion Criteria 

• eGFR <15ml/min in last 2 months 

• Triglycerides >10mmol/L in last 2 months 

• Alcohol intake above recommended units/week 

• Biliary or pancreatic surgery/disease within last 6 months 

• History of pancreatitis  

• Heart failure NYHA class IV 

• Gastroparesis 

• Inflammatory bowel disease 

• Planned pregnancy, inadequate contraception or breastfeeding  

• Retinopathy  

Findings 

Case Example 

• 56 YO T2DM for almost 1 year (had extensive CVD and fatty liver and weighed >200kg at diagnosis) 

• Weight pre Mounjaro was 156kg – 3 months into optimisation got down to 142kg (starting BMI> 45 reduced to <40kg/m2) 

• Was able to come off his antihypertensives (regular BP of <110/60) 

• No longer taking metformin  

• Regained virility and was no longer in need of Tadalafil 

• Was able to purchase a road bike and increase mobility  

• Hba1c dropped from 49 to 40 

• “Thanks to the team I got my life back and started to believe change was possible”