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Check vitamin B12 levels in people treated with metformin who have symptoms suggestive of vitamin B12 deficiency This will also include patients found to have megaloblastic anaemia (raised mean corpuscular volume [MVC]), who may be asymptomatic (MHRA, 2022)

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If a GLP-1 or dual agonist is not appropriate for you, a provider will work with you to determine an effective medication for your health profile

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Janna Goldfeld, PA-C Janna Goldfeld, PA-C, is a nationally board-certified Physician Assistant with more than 20 years of experience in family medicine, internal medicine, ENT, general surgery, and bariatric/weight loss care

Actionable Next Steps For Wellness Professionals: Develop educational resources about cagrilintide and retatrutide based on current evidence Establish referral relationships with qualified medical professionals for peptide therapy consultations Create monitoring protocols for clients using metabolic peptides (regardless of specific compounds) Stay current with research by setting alerts for publications on these compounds Focus on evidence-based nutrition, training, and lifestyle interventions that complement any medical therapies For Individuals Interested in These Peptides: Consult qualified medical professionalsendocrinologists or obesity medicine specialists Consider clinical trial participation for access to cutting-edge therapies with proper oversight Explore evidence-based alternatives like CagriSema (when approved) rather than experimental combinations Implement comprehensive lifestyle modifications that enhance any peptide therapy outcomes Maintain realistic expectations based on clinical trial data rather than anecdotal reports The future of metabolic health likely includes sophisticated peptide combinations that address multiple pathways simultaneously