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Adjunct alongside a GLP-1 , where B12 or nutrient repletion is independently indicated

Food and Drug Administration (FDA) as a weight loss medication

Together, these two pathways produce a broader metabolic response than GLP-1 activation alone, which is why tirzepatide has shown more pronounced effects on body weight and blood sugar control in clinical research compared to GLP-1-only medications

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Recent observations highlighted the critical association with intestinal flora, as confirmed by the finding that metformin decreased the relative abundance of Bacteroides fragilis while increasing Akkermansia muciniphila and Bifidobacterium bifidum