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These medications are typically prescribed when lifestyle modifications and oral diabetes medications have not achieved adequate glycaemic control, or as part of a comprehensive weight management programme for eligible patients

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Data extraction and risk of bias assessment Two researchers extracted data including the characteristics of the study population (number of patients per group, age, sex, diabetic status, liver disease status [NAFLD or NASH], and BMI per group), intervention(s) (TZD or GLP-1RA, treatment duration), control(s), outcome(s), and study results for each outcome according to a predefined Excel format

Stop taking Mounjaro immediately and seek urgent medical assessment Signs of dehydration from persistent vomiting or diarrhoea: reduced urination, extreme thirst, confusion, or dizziness Symptoms of hypoglycaemia that do not resolve with usual measures: confusion, loss of consciousness, seizures Contact your GP or diabetes specialist nurse promptly if you notice: Persistent or worsening gastrointestinal symptoms that interfere with nutrition, hydration, or quality of life Right upper abdominal pain, fever, or yellowing of the skin/eyes (jaundice), which could indicate gallbladder problems New or unexplained symptoms such as severe headaches or palpitations If you have diabetic retinopathy and notice vision changes, seek prompt review Symptoms suggestive of thyroid abnormalities: a lump in the neck, hoarseness, difficulty swallowing, or persistent cough Recurrent skin reactions, unexplained rashes, or injection site problems Difficulty managing blood glucose levels or frequent hypoglycaemic episodes For urgent but non-emergency concerns , contact NHS 111 for advice, especially outside of GP hours

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